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Küng AJ, Dykun I, Totzeck M, Mincu R, Michel L, Kill C, Witzke O, Buer J, Rassaf T, Mahabadi AA. Epicardial adipose tissue in patients with and without COVID-19 infection. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2025; 54:100548. [PMID: 40322277 PMCID: PMC12049814 DOI: 10.1016/j.ahjo.2025.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 02/09/2025] [Accepted: 04/18/2025] [Indexed: 05/08/2025]
Abstract
Background Acute COVID-19 infection frequently affects the cardiovascular system and causes acute myocardial injury. Epicardial Adipose Tissue (EAT), a visceral adipose tissue surrounding the myocardium and coronary arteries, has unique paracrine and endocrine effects, modulating the heart's inflammatory environment. Systemic inflammation stimulates TNF-α and Interleukin-6 secretion from EAT, contributing to cytokine storms and intensifying systemic responses. We aimed to determine whether EAT amount differs in patients with and without acute COVID-19 infection and myocardial injury. Methods This study analyzed the CoV-COR registry cohort, conducted at the University Hospital Essen, including patients with symptoms suggestive of COVID-19 infection. The infection was confirmed by PCR. EAT thickness was measured by two-dimensional TTE. Results A total of 296 patients (mean age 63.6 ± 17.26 years, 55.4 % male) were included. Patients with confirmed COVID-19 infection were younger, more frequently treated with antihypertensive medication, and had higher BMI and systolic blood pressures. Univariate logistic regression showed no association between EAT and myocardial injury 0.97 (0.74; 1.28, p = 0.82). A trend towards an association was observed between increasing EAT thickness and COVID-19 infection 1.25 (0.99; 1.59, p = 0.060). Adjusting for age and gender strengthened the association, with a 48 % (1.14; 1.93, p = 0.004) increased odds of COVID-19 infection per increase in EAT thickness. Multivariable regression yielded consistent effect sizes 1.47 (1.01; 2.16, p = 0.047). Conclusion EAT thickness is associated with the presence of an acute COVID-19 infection but not with a myocardial injury. Further research is needed to assess if systemic viral infection induces dynamic changes in EAT.
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Affiliation(s)
- Alexander J. Küng
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr, 55, 45147 Essen, Germany
| | - Iryna Dykun
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr, 55, 45147 Essen, Germany
| | - Matthias Totzeck
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr, 55, 45147 Essen, Germany
| | - Raluca Mincu
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr, 55, 45147 Essen, Germany
| | - Lars Michel
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr, 55, 45147 Essen, Germany
| | - Clemens Kill
- Center for Emergency Medicine, University Hospital Essen, Essen, Germany
| | - Oliver Witzke
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, Essen, Germany
| | - Jan Buer
- Institute of Medical Microbiology, University Hospital Essen, Germany
| | - Tienush Rassaf
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr, 55, 45147 Essen, Germany
| | - Amir A. Mahabadi
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Hufelandstr, 55, 45147 Essen, Germany
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Llorca J, Gómez-Acebo I, Alonso-Molero J, Delgado-Rodríguez M, Dierssen-Sotos T. Direct and indirect burden of COVID-19 on mortality in Spain (2020 to 2022). BMC Public Health 2025; 25:1885. [PMID: 40405159 PMCID: PMC12096484 DOI: 10.1186/s12889-025-23077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Accepted: 05/07/2025] [Indexed: 05/24/2025] Open
Abstract
BACKGROUND Life expectancy in high-income countries remained lower in 2022 compared to pre-pandemic levels in 2019. This study explores the deficit of life expectancy and excess of years of life lost (YLL) in Spain from 2020 to 2022, assessing both direct effects of infectious diseases and indirect effects of other causes of death. METHODS Data on life expectancy and YLL from 2010 to 2022 were obtained from the Spanish Institute for Statistics (INE). Using linear regression, we estimated expected life expectancy and YLL for 2020-2022 under the assumption that pre-pandemic trends (2010-2019) had continued. RESULTS During the first year of the pandemic, Spanish women lost 1.10 years and men lost 1.40 years in life expectancy. By 2022, life expectancy remained lower than in 2019 for both sexes. The excess YLL was similar across 2020 (2.40 million YLL and 5.3 YLL/100 people), 2021 (2.35 million YLL, 5.1 YLL/100 people), and 2022 (2.35 million YLL, 5.0 YLL/100 people). Approximately 70% of this excess was attributable to infectious diseases (87% in 2020, 78% in 2021, and 43% in 2022). Other major contributors to excess YLL included external causes, circulatory diseases, digestive diseases, and endocrine, nutritional, and metabolic diseases, while cancer mortality did not show an excess during the pandemic period. CONCLUSIONS Mortality in Spain in 2022 remained elevated compared to pre-pandemic expectations. The contribution of non-infectious diseases to excess mortality increased over time. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Javier Llorca
- Preventive Medicine Group, University of Cantabria, Santander, Spain
| | - Inés Gómez-Acebo
- Preventive Medicine Group, University of Cantabria, Santander, Spain.
- IDIVAL-Valdecilla Health Research Institute, Santander, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain.
| | - Jéssica Alonso-Molero
- Preventive Medicine Group, University of Cantabria, Santander, Spain
- IDIVAL-Valdecilla Health Research Institute, Santander, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
| | - Miguel Delgado-Rodríguez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
- Division of Preventive Medicine and Public Health, University of Jaen, Jaen, Spain
| | - Trinidad Dierssen-Sotos
- Preventive Medicine Group, University of Cantabria, Santander, Spain
- IDIVAL-Valdecilla Health Research Institute, Santander, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Institute of Health Carlos III, Madrid, Spain
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Saminathan P, Mathews IT, Alimadadi A, Fung K, Kakugawa K, Joosten LA, Netea MG, Jain M, Cheng S, Hedrick CC, Sharma S. Sex differences in adenosine deaminase activity associate with disparities in SARS-CoV-2 innate immunity. iScience 2025; 28:112418. [PMID: 40343269 PMCID: PMC12059719 DOI: 10.1016/j.isci.2025.112418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2024] [Revised: 01/08/2025] [Accepted: 04/09/2025] [Indexed: 05/11/2025] Open
Abstract
Females demonstrate elevated type-I interferon production and a stronger antiviral immune response; however, the mechanisms underlying sex-based differences in antiviral immunity are incompletely understood. We previously reported that low adenosine deaminase (ADA) activity perturbs the methylation-based transcriptional silencing of endogenous retroviral elements (hERV), which stimulates IFN-Stimulated Genes (ISG) and primes antiviral immunity. Here we demonstrate lower ADA activity in females compared to their male counterparts, which correlated with higher hERV and ISG expression in female lungs. Sex differences in ADA2 were linked to the number and expression profiles of blood and lung-derived monocyte populations. Single-cell RNA sequencing of respiratory cells from patients with COVID-19 showed a significant female bias in hERV-ISG signatures, and implicated IL-18 as a driver of sex-specific ADA2 expression. Observations in healthy and COVID-19 cohorts indicate that higher ADA activity is associated with suppressed antiviral innate immunity in the male respiratory tract, which may drive adverse COVID-19 outcomes.
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Affiliation(s)
- Priyanka Saminathan
- Center for Sex Differences in the Immune System, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Ian T. Mathews
- Center for Sex Differences in the Immune System, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Ahmad Alimadadi
- Center for Sex Differences in the Immune System, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
- Immunology Center of Georgia and Georgia Cancer Center, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
| | - Kai Fung
- Center for Sex Differences in the Immune System, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
| | - Kiyokazu Kakugawa
- Laboratory for Inflammatory Immune Metabolism, RIKEN Center for Integrative Medical Sciences, Yokohama City, Kanagawa 230-0045, Japan
| | - Leo A.B. Joosten
- Department of Internal Medicine and Radboud Community Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
- Department of Medical Genetics, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Mihai G. Netea
- Department of Internal Medicine and Radboud Community Center for Infectious Diseases, Radboud University Medical Center, 6525 GA Nijmegen, the Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn 53127, Germany
| | - Mohit Jain
- Sapient Bioanalytics, San Diego, CA 92121, USA
| | - Susan Cheng
- Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Catherine C. Hedrick
- Immunology Center of Georgia and Georgia Cancer Center, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA
| | - Sonia Sharma
- Center for Sex Differences in the Immune System, La Jolla Institute for Immunology, La Jolla, CA 92037, USA
- Laboratory for Inflammatory Immune Metabolism, RIKEN Center for Integrative Medical Sciences, Yokohama City, Kanagawa 230-0045, Japan
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Tomalka JA, Owings A, Galeas-Pena M, Ziegler CGK, Robinson TO, Wichman TG, Laird H, Williams HB, Ghaliwal NS, Everman S, Zafar Y, Walsh JML, Shalek AK, Horwitz BH, Ordovas-Montanes J, Glover SC, Gibert Y. Enhanced Production of Lipid Mediators in Plasma and Activation of DNA Damage Pathways in PBMCs Are Correlated With the Severity of Ancestral SARS-CoV-2 Infection. FASEB J 2025; 39:e70600. [PMID: 40322970 DOI: 10.1096/fj.202403195r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Revised: 03/28/2025] [Accepted: 04/24/2025] [Indexed: 05/14/2025]
Abstract
Many questions remain unanswered regarding the implication of genetics and lipid metabolites with severe SARS-CoV-2 infections. We performed bulk RNA-seq and a total fatty acid panel analysis on PBMCs and plasma collected from 10 infected and 10 uninfected patients. Univariate comparison of lipid metabolites using the Mann-Whitney U-test revealed that six lipid metabolites were significantly increased in COVID-19 patients, including the lipid mediators arachidonic acid (AA) and eicosapentaenoic acid (EPA), which both give rise to eicosanoids. Key lipids implicated in inflammation, including AA and EPA, along with the fatty acids DHA and DPA, were significantly and positively correlated to the WHO disease severity score. Analysis of our bulk RNA-seq dataset demonstrated distinct transcriptional profiles leading to a segregation of COVID-19 patients based on the WHO score. Ontology, KEGG, and Reactome analysis identified several key pathways and nodes that were enriched for genes related to innate immunity, interactions between lymphoid and nonlymphoid cells, interleukin signaling, and subsequent DNA damage pathways. EPA levels correlated with heightened cell cycling and DNA damage pathways observed in patients with a high WHO score. We studied gene expression in nasopharyngeal swabs from 58 healthy and COVID-19 participants and identified that genes implicated in eicosanoid synthesis, such as alox5, alox12, and alox15B, were specifically up-regulated in high WHO score patients in several cell types of the nasopharynx, especially goblet cells across different viral variants (Deta and Omicron). Using published nasal scRNA-seq datasets from COVID-19 patients, we evaluated the expression of genes implicated in eicosanoid synthesis, such as ALOX5, ALOX15, and ALOX15B, across nasal cell types and COVID-19 severity groups. Altogether, our study highlights the fact that the increase in specific lipids implicated in inflammation and the genes required for their synthesis correlated with the severity of the SARS-CoV-2 infection.
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Affiliation(s)
- Jeffrey A Tomalka
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Owings
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Michelle Galeas-Pena
- Department of Medicine, Section of Gastroenterology and Hepatology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Carly G K Ziegler
- Program in Health Sciences & Technology, Harvard Medical School & MIT, Boston, Massachusetts, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Harvard Graduate Program in Biophysics, Harvard University, Cambridge, Massachusetts, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Tanya O Robinson
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Thomas G Wichman
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Hannah Laird
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Haley B Williams
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Neha S Ghaliwal
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Steven Everman
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Yousaf Zafar
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Jaclyn M L Walsh
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alex K Shalek
- Program in Health Sciences & Technology, Harvard Medical School & MIT, Boston, Massachusetts, USA
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Harvard Graduate Program in Biophysics, Harvard University, Cambridge, Massachusetts, USA
- Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
- Department of Chemistry, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Harvard Stem Cell Institute, Cambridge, Massachusetts, USA
| | - Bruce H Horwitz
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jose Ordovas-Montanes
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
- Department of Immunology, Harvard Medical School, Boston, Massachusetts, USA
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Stem Cell Institute, Cambridge, Massachusetts, USA
| | - Sarah C Glover
- Department of Medicine, Section of Gastroenterology and Hepatology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Yann Gibert
- Department of Cell and Molecular Biology, University of Mississippi Medical Center, Jackson, Mississippi, USA
- Cancer Center and Research Institute, University of Mississippi Medical Center, Jackson, Mississippi, USA
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5
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Bepouka B, Mandina M, Mvibudulu D, Matangila J, Okamba A, Muyeke G, Tawaba D, Mayasi N, Odio O, Mangala D, Lukiana T, Mbula M, Situakibanza H, Longokolo M. Clinical Characteristics and Mortality Trends Among COVID-19 Patients During the First Four Waves in Ngaliema Clinic, Democratic Republic of the Congo. Infect Drug Resist 2025; 18:2525-2536. [PMID: 40384799 PMCID: PMC12085894 DOI: 10.2147/idr.s499371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2024] [Accepted: 05/10/2025] [Indexed: 05/20/2025] Open
Abstract
Background COVID-19 disease has been a deadly pandemic in different waves in the Democratic Republic of Congo. However, knowledge of the clinical characteristics of COVID-19 patients and the factors associated with death during different waves is important. Methods We conducted a retrospective cohort of 410 patients hospitalized during 4 waves of COVID-19, from March 20, 2020, to January 2, 2022, at the Ngaliema clinic in DR Congo. We included any patient hospitalized for COVID-19 with biological confirmation by RT-PCR. Factors associated with death were investigated using logistic regression. Results During the 4 waves of the COVID-19 pandemic at Clinique Ngaliema, complaints on admission were most often fever, cough and physical asthenia. Death was most common in the elderly, hypertensive and diabetic patients, those with elevated CRP and hyper leukocytosis. Mortality was highest in the 1st wave (28%), followed by the 3rd wave (27%), then the 2nd (22%) and 4th waves (21%). Factors associated with death were hyper leukocytosis (ORa: 2.76; CI 95%: 1.25-6.1), severe disease stage (ORa 21.24; CI 95%: 1.87-24). Vitamin C 500 mg twice a day use was protective (ORa: 0.24; CI 95%: 0.08-0.72). Conclusion COVID-19 disease poses a real public health problem, with non-negligible mortality. Factors associated with death were degree of disease severity, hyper leukocytosis and non-use of vitamin C. Taking these factors into account will help clinicians and decision-makers to anticipate future waves of the pandemic.
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Affiliation(s)
- Ben Bepouka
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Office of Infectious Diseases and Global Health Research, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Madone Mandina
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Daniel Mvibudulu
- Faculty of Medicine, Kongo University, Kisantu, Democratic Republic of the Congo
- Emergency Service, Ngaliema Clinic, Kinshasa, Democratic Republic of the Congo
| | - Junior Matangila
- Emergency Service, Ngaliema Clinic, Kinshasa, Democratic Republic of the Congo
| | - Armand Okamba
- Cardiology Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Gertrude Muyeke
- Faculty of Medicine, Kongo University, Kisantu, Democratic Republic of the Congo
| | - Dieudonne Tawaba
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
- Office of Infectious Diseases and Global Health Research, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Nadine Mayasi
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Ossam Odio
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Donat Mangala
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Tuna Lukiana
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Marcel Mbula
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Hippolyte Situakibanza
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
| | - Murielle Longokolo
- Infectious and Tropical Diseases Service, Kinshasa University Hospital, Kinshasa, Democratic Republic of the Congo
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6
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Adamuz J, González-Samartino M, Jiménez-Martínez E, Tapia-Pérez M, López-Jiménez MM, Valero-Valdelvira P, Zuriguel-Pérez E, Berbis-Morelló C, Asensio-Flores S, Juvé-Udina ME. Impact of nurse staffing coverage and care complexity factors on health outcomes in hospitalized COVID-19 patients: a cross-sectional study. BMC Nurs 2025; 24:520. [PMID: 40361094 PMCID: PMC12076968 DOI: 10.1186/s12912-025-03142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 04/29/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND Few studies have captured the impact of inadequate nurse staffing levels and broader health patient conditions in admitted patients during the COVID-19 pandemic. We aimed to determine the association between nurse staffing coverage, care complexity individual factors (CCIFs) and adverse events (AEs) in patients admitted with COVID-19. METHODS A multicentre cross-sectional study was conducted from March 1, 2020 to March 31, 2022 at eight public health hospitals in Spain. All patients with COVID-19 who were admitted to these hospitals were included. The main variables included AEs, nurse staffing coverage (as measured using the ATIC patient classification system) and CCIFs to evaluate broader patient health conditions. Adjusted logistic models were performed to identify associations with AEs, stratified by patients admitted to wards and hospitalized patients who required admission to intensive care units (ICUs). RESULTS A total of 11,968 hospitalized patients, 2,824 (23.6%) experienced AEs. Multivariate analysis showed that higher levels of nurse staffing coverage protected against AEs. Among patients admitted to acute wards, the independent risk factors for AEs included old age, haemodynamic instability, chronic disease, uncontrolled pain, urinary or faecal incontinence and mental status impairments. In addition to these factors, extreme weight, position impairment and communication disorders were factors associated with AEs in patients who required ICU admission. CONCLUSIONS Nurse staffing coverage was a protective factor for AEs. Several CCIFs related to comorbidity/complications, developmental, and mental-cognitive domains were strongly associated with AEs. Therefore, ensuring safe nurse staffing levels could be improve patient outcomes.
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Affiliation(s)
- Jordi Adamuz
- Nursing Knowledge Management and Information Systems Department, Hospital Universitari de Bellvitge - IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat (Barcelona), 08907, Spain.
- Faculty of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain.
- IDIBELL, Bellvitge Institute of Biomedical Research, Barcelona, Spain.
| | - Maribel González-Samartino
- Nursing Knowledge Management and Information Systems Department, Hospital Universitari de Bellvitge - IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat (Barcelona), 08907, Spain
- Faculty of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain
- Nursing Management Team, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL, Bellvitge Institute of Biomedical Research, Barcelona, Spain
| | - Emilio Jiménez-Martínez
- Faculty of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain
- Infectious Disease Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL, Bellvitge Institute of Biomedical Research, Barcelona, Spain
| | - Marta Tapia-Pérez
- Nursing Knowledge Management and Information Systems Department, Hospital Universitari de Bellvitge - IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat (Barcelona), 08907, Spain
- IDIBELL, Bellvitge Institute of Biomedical Research, Barcelona, Spain
| | - María-Magdalena López-Jiménez
- Nursing Knowledge Management and Information Systems Department, Hospital Universitari de Bellvitge - IDIBELL, Feixa Llarga s/n, L'Hospitalet de Llobregat (Barcelona), 08907, Spain
- Faculty of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain
- IDIBELL, Bellvitge Institute of Biomedical Research, Barcelona, Spain
| | - Patricia Valero-Valdelvira
- Research Group on Innovation, Health Economics, and Digital Transformation (INEDIT), Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Esperanza Zuriguel-Pérez
- Nurse Research Coordinator, VHIR, Vall d'Hebron Institute of Biomedical Research, Barcelona, Spain
| | | | - Susana Asensio-Flores
- Nursing Management Team, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
- IDIBELL, Bellvitge Institute of Biomedical Research, Barcelona, Spain
| | - Maria-Eulàlia Juvé-Udina
- IDIBELL, Bellvitge Institute of Biomedical Research, Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
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7
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Parashar L, Meshram GG, Vig SL, Prasad J. Evolution of COVID-19 mortality risk: A retrospective study of three epidemic waves in Faridabad, India. Semergen 2025; 51:102494. [PMID: 40345023 DOI: 10.1016/j.semerg.2025.102494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/18/2025] [Accepted: 03/20/2025] [Indexed: 05/11/2025]
Abstract
PURPOSE The study aimed to compare the sociodemographic, comorbidity, and clinical variables associated with coronavirus disease 2019 (COVID-19) mortality across three distinct epidemic waves in Faridabad, India. METHODS A retrospective analysis of the medical records of patients admitted with COVID-19 was conducted at a tertiary care center at Faridabad, India. COVID-19 epidemic waves were categorized into the first wave (April 2020-January 2021), second wave (March 2021-June 2021), and third wave (December 2021-February 2022). Sociodemographic, comorbidity, and clinical parameters were assessed for their association with mortality in each of the waves by the Chi-square test. The Cochran-Armitage test for trend was used to assess changes in these associations with respect to the mortality rate across the epidemic waves. RESULTS A total of 5217 patient records were assessed, with 4066 in the first wave, 895 in the second wave, and 256 in the third wave. Across all waves, comorbidities (diabetes and hypertension), multimorbidity, severe disease (requiring intensive care unit admission and ventilator support) were consistently associated (p<0.05) with higher mortality. While sociodemographic factors were significant (p<0.05) in the first two waves, their impact diminished in the third. Clinical symptoms, particularly 'cold and flu' showed consistent significance (p<0.05) across all waves. COVID-19 mortality trend peaked in the second wave, disproportionately (p<0.05) affecting females, older patients, and those with comorbidities or severe symptoms. CONCLUSIONS Understanding the shifting risk factors across COVID-19 epidemic waves is crucial for targeted interventions. Prioritizing high-risk groups, particularly during peak waves, can optimize resource allocation and minimize mortality.
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Affiliation(s)
- L Parashar
- Department of Statistics, Amity School of Applied Sciences, Amity University, Jaipur 303002, Rajasthan, India
| | - G G Meshram
- Department of Pharmacology, Maulana Azad Medical College and Associated Hospitals, New Delhi 110002, India.
| | - S L Vig
- Department of Community Medicine, Employees' State Insurance Corporation Medical College and Hospital, Faridabad 121001, Haryana, India
| | - J Prasad
- Department of Statistics, Amity School of Applied Sciences, Amity University, Jaipur 303002, Rajasthan, India
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8
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Bizuneh FK, Biwota GT, Tsheten T, Bizuneh TK. Incidence of recovery rate and predictors among hospitalized COVID- 19 infected patients in Ethiopia; a systemic review and meta-analysis. BMC Public Health 2025; 25:1644. [PMID: 40319254 PMCID: PMC12049009 DOI: 10.1186/s12889-025-22841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2024] [Accepted: 04/17/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Despite global efforts to mitigate COVID-19 infection through vaccination and therapeutic interventions, morbidity and mortality rates continued at variable rates. Although mortality risk and clinical features of COVID-19 are well-documented, recovery patterns and prognostic factors post-admission remain inconclusive, particularly in resource-limited settings like Ethiopia. This systematic review and meta-analysis (SRM) aimed to estimate the pooled incidence rate of recovery and predictors among hospitalized COVID-19 patients in Ethiopia. METHODS We searched (N = 1,191) articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline from PubMed/MEDLINE (N = 755), Scopus (N = 137), Web of Science (N = 84), Science Direct (N = 148), Cochran (N = 25), and Google Scholar searching (N = 42) from December 2019 to February 2024. The data were extracted using a Microsoft Excel spreadsheet and exported to Stata TM version 17.0 for further analysis. The Article quality was assessed using the Joanna Briggs Institute checklist. The pooled incidence rate of recovery was estimated using a weighted inverse variance random-effects meta-regression. Heterogeneity among studies was evaluated using the I2 statistic. Subgroup analyses and sensitivity tests were also conducted to explore publication bias. This file is registered in international Prospero with ID (CRD42024518569). RESULT Sixteen (N = 16) published studies with 7,676 hospitalized COVID-19 patients were included in the final report. The mean age of participants ranged from 29 (± 17) to 57.5 (± 3) years, with male patients constituting the largest proportion of participants, 4,491(58.5%). During recovery screening, 6,304(82.21%) cases were discharged as improved, 159 (2.1%) attriters, and 818 (10.6%) died during inpatient treatment. The pooled incidence of recovery, mortality, and attrition rates were found to be 82.32% (95% CI: 78.81-85.83; I2 = 94.8%), 14.3% (I2 = 98.45%), and 2.7% (I2 = 81.34%), respectively. Incidence of recovery rate varied across regions and epidemic phases, with the highest rate observed in Addis Ababa (89.94%, I2 = 78.33%) and the lowest reported in the Tigray region (59.7%, I2 = 0.0%). Across epidemic phases, the recovery rate was 88.05% (I2 = 29.56%) in Phase II, 84.09% (I2 = 97.57%) in Phase I, and 78.92% (I2 = 96.9%) in Phase III, respectively. Factors included being aged 15-30 years (pooled OR = 2.01), male sex (pooled OR = 1.46), no dyspnea (pooled OR = 2.4; I2 = 79%), and no baseline comorbidities (pooled OR = 1.15; I2 = 89.3%) were predictors for recovery. CONCLUSION AND RECOMMENDATION: In Ethiopia, more than eight out of ten hospitalized COVID-19 patients recovered after inpatient treatment. However, the incidence of recovery rates varied significantly across epidemic phases, study settings, and regions. Factors including younger age, male sex, no dyspnea (shortness of breathing), and no underlying comorbidity heightened recovery. It is highly recommended those inpatients cares should focus on high-risk groups (older adults) and implement standardized treatment protocols in each study setting. Regions with lower recovery rates need aid in logistical support and training for healthcare providers.
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Affiliation(s)
| | - Getaye Tizazu Biwota
- College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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9
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Dei Cas A, Aldigeri R, Eletto E, Ticinesi A, Nouvenne A, Prati B, Vazzana A, Antonini M, Moretti V, Balestreri E, Spigoni V, Fantuzzi F, Schirò S, Ruffini L, Sverzellati N, Meschi T, Bonadonna R. Hyperglycemia in the diabetic range, but not previous diagnosis of diabetes mellitus, is an independent indicator of poor outcome in patients hospitalized for severe COVID-19. Acta Diabetol 2025:10.1007/s00592-025-02507-1. [PMID: 40314776 DOI: 10.1007/s00592-025-02507-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Accepted: 03/29/2025] [Indexed: 05/03/2025]
Abstract
AIMS Diabetes mellitus (DM) and hyperglycemia are associated with poor outcome(s) in COVID-19 hospitalized patients, but their independent impact on prognosis remains unclear. We aimed to assess the impact of DM and hyperglycemia on COVID-19 outcomes. METHODS Clinical data/records from COVID-19 patients admitted to the Parma University-Hospital (February 23rd to March 31st, 2020) were retrieved and analysed (NCT04550403). Fasting plasma glucose (FPG), inflammatory markers and the main biochemical variables were collected at admission. Patients underwent chest high-resolution CT and arterial blood gas analysis to determine the PaO2/FiO2 ratio (P/F ratio). The primary outcome was a composite of intensive care unit admission and/or death. RESULTS Among 756 subjects, 143 (19%) had DM. These patients were older with higher comorbidity rates. The primary outcome occurred in 61.5% DM patients versus 43.4% without DM (p < 0.001). In multivariable analysis (accuracy UC = 0.93), older age, cardiovascular and kidney diseases, FPG ≥ 126 mg/dl, C-reactive protein, and P/F ratio, but not previous DM, were independent risk indicators. CONCLUSIONS DM indicated poor COVID-19 outcomes, but not when adjusted for other clinical variables/comorbities, suggesting that its impact was mostly driven by concomitant factors. The independent role of fasting hyperglycemia points to the need for further research on its contribution to COVID-19.
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Affiliation(s)
- Alessandra Dei Cas
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Raffaella Aldigeri
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Elisa Eletto
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Andrea Ticinesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Care Continuity and Multicomplexity, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Antonio Nouvenne
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Care Continuity and Multicomplexity, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Beatrice Prati
- Department of Care Continuity and Multicomplexity, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Angela Vazzana
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Monica Antonini
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Valentina Moretti
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Emanuela Balestreri
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy
| | - Valentina Spigoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federica Fantuzzi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Silvia Schirò
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Livia Ruffini
- Nuclear Medicine, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Radiological Sciences, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Tiziana Meschi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Care Continuity and Multicomplexity, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Riccardo Bonadonna
- Endocrinology and Metabolic Diseases, Azienda Ospedaliero-Universitaria of Parma, Via Gramsci 14, 43126, Parma, Italy.
- Department of Medicine and Surgery, University of Parma, Parma, Italy.
- Endocrinology, Diabetology and Metabolic Diseases, University of Verona and University Hospital of Verona, Verona, Italy.
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10
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Abou Hamed A, Gourraud M, Genet T, Barbier F, Angoulvant D, Fauchier L, Ivanes F. Prognosis of patients with acute myocardial infarction in the setting of COVID-19: A French nationwide observational study. Arch Cardiovasc Dis 2025; 118:312-321. [PMID: 40157843 DOI: 10.1016/j.acvd.2025.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Revised: 01/23/2025] [Accepted: 01/27/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND The prognosis of patients with acute myocardial infarction (AMI) in the setting of coronavirus disease 2019 (COVID-19) remains uncertain. AIMS To evaluate patients' prognosis after an AMI concomitant with COVID-19. METHODS This retrospective nationwide observational cohort study was based on the French administrative hospital discharge database. Primary outcomes were incidences of all-cause death, cardiovascular death, heart failure (HF), recurrence of AMI, ischaemic stroke, incident atrial fibrillation (AF), ventricular tachycardia/ventricular fibrillation (VT/VF) and cardiac arrest. Patients with AMI and COVID-19 were matched to those without COVID-19 (using propensity score matching techniques) to account for differences between the two populations. RESULTS A total of 288,408 patients hospitalized for AMI in France from March 2020 to January 2023 were included; 26,879 had a COVID-19-positive test between 15 days before to 5 days after admission. Patients with COVID-19 were older, more frequently had diabetes mellitus and obesity but less frequently smoked. They more frequently had non-ST-segment elevation myocardial infarction presentation and more often had lung disease. After matching, patients with COVID-19 had higher risks of all-cause death (hazard ratio [HR] 1.255; 95% confidence interval [CI] 1.203-1.308; P<0.0001), HF (HR 1.205; 95% CI 1.159-1.254; P<0.0001), ischaemic stroke (HR 1.237; 95% CI 1.084-1.411; P=0.002), incident AF (HR 1.160; 95% CI 1.070-1.258; P=0.0003) and VT/VF (1.360; 95% CI 1.200-1.540; P<0.0001). Surprisingly, cardiovascular death risk was lower in patients with COVID-19 (HR 0.932; 95% CI 0.879-0.988; P=0.02) as a result of competition with non-cardiovascular death. No statistical difference was found for cardiac arrest or recurrent AMI. CONCLUSION In this French nationwide cohort study, AMI in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) increased all-cause death incidence compared to non-infected AMI, but this poorer prognosis was not due to cardiovascular death. Further investigations are needed to elucidate the aetiologies of death.
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Affiliation(s)
| | - Maeva Gourraud
- Cardiology Department, Tours University Hospital, Tours, France
| | - Thibaud Genet
- Cardiology Department, Tours University Hospital, Tours, France
| | - François Barbier
- Medical intensive Care Unit, Orléans University Hospital, Orléans, France
| | - Denis Angoulvant
- Cardiology Department, Tours University Hospital, Tours, France; UMR Inserm 1327 ISCHEMIA, University of Tours, Tours, France
| | - Laurent Fauchier
- Cardiology Department, Tours University Hospital, Tours, France; UMR Inserm 1327 ISCHEMIA, University of Tours, Tours, France
| | - Fabrice Ivanes
- Cardiology Department, Tours University Hospital, Tours, France; UMR Inserm 1327 ISCHEMIA, University of Tours, Tours, France.
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11
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Maguire C, Soloveichik E, Blinchevsky N, Miller J, Morrison R, Busch J, Michael Brode W, Wylie D, Rousseau J, Melamed E. Dissecting clinical features of COVID-19 in a cohort of 21,312 acute care patients. COMMUNICATIONS MEDICINE 2025; 5:138. [PMID: 40281203 PMCID: PMC12032146 DOI: 10.1038/s43856-025-00844-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/04/2025] [Indexed: 04/29/2025] Open
Abstract
BACKGROUND Although, COVID-19 has resulted in over 7 million deaths globally, many questions still remain about the risk factors for disease severity and the effects of variants and vaccinations over the course of the pandemic. To address this gap, we conducted a retrospective analysis of electronic health records from COVID-19 patients over 2.5 years of the COVID-19 pandemic to identify associated clinical features. METHODS We analyze a retrospective cohort of 21,312 acute-care patients over a 2.5 year period and define six clinical trajectory groups (TGs) associated with demographics, diagnoses, vitals, labs, imaging, consultations, and medications. RESULTS We show that the proportion of mild patients increased over time, particularly during Omicron waves. Additionally, while mild and fatal patients had differences in age, age did not distinguish patients with severe versus critical disease. Furthermore, we find that both male sex and Hispanic/Latino ethnicity are associated with more severe/critical TGs. More severe patients also have a higher rate of neuropsychiatric diagnoses and consultations, along with an immunological signature of high neutrophils and immature granulocytes, and low lymphocytes and monocytes. Interestingly, low albumin is one of the best lab predictors of COVID-19 severity in association with higher malnutrition in severe/critical patients, raising concern of nutritional insufficiency influencing COVID-19 outcomes. Despite this, only a small fraction of severe/critical patients had nutritional labs checked (e.g. Vitamin D, thiamine, B vitamins) or received vitamin supplementation. CONCLUSIONS Our findings expand on clinical risk factors in COVID-19, and highlight the interaction between severity, nutritional status, and neuropsychiatric complications in acute care patients to enable identification of patients at risk for severe disease.
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Affiliation(s)
- Cole Maguire
- Department of Neurology, The University of Texas at, Austin, Dell Medical School, Austin, TX, USA
| | - Elie Soloveichik
- Department of Neurology, The University of Texas at, Austin, Dell Medical School, Austin, TX, USA
| | - Netta Blinchevsky
- Department of Neurology, The University of Texas at, Austin, Dell Medical School, Austin, TX, USA
| | - Jaimie Miller
- Enterprise Data Intelligence, The University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - Robert Morrison
- Department of Internal Medicine, The University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - Johanna Busch
- Department of Internal Medicine, The University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - W Michael Brode
- Department of Internal Medicine, The University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - Dennis Wylie
- Center for Biomedical Support, The University of Texas at Austin, Austin, TX, USA
| | - Justin Rousseau
- Department of Neurology, The University of Texas at, Austin, Dell Medical School, Austin, TX, USA
- Biostatistics and Clinical Informatics Section, Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Esther Melamed
- Department of Neurology, The University of Texas at, Austin, Dell Medical School, Austin, TX, USA.
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12
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Hernández-Monsalves AH, Letelier P, Morales C, Rojas E, Saez MA, Coña N, Díaz J, San Martín A, Garcés P, Espinal-Enriquez J, Guzmán N. A Machine Learning Model for Predicting Intensive Care Unit Admission in Inpatients with COVID-19 Using Clinical Data and Laboratory Biomarkers. Biomedicines 2025; 13:1025. [PMID: 40426855 DOI: 10.3390/biomedicines13051025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2025] [Revised: 04/19/2025] [Accepted: 04/20/2025] [Indexed: 05/29/2025] Open
Abstract
Background: Artificial intelligence tools can help improve the clinical management of patients with severe COVID-19. The aim of this study was to validate a machine learning model to predict admission to the Intensive Care Unit (ICU) in individuals with COVID-19. Methods: A total of 201 hospitalized patients with COVID-19 were included. Sociodemographic and clinical data as well as laboratory biomarker results were obtained from medical records and the clinical laboratory information system. Three machine learning models were generated, trained, and internally validated: logistic regression (LR), random forest (RF), and extreme gradient boosting (XGBoost). The models were evaluated for sensitivity (Sn), specificity (Sp), area under the curve (AUC), precision (P), SHapley Additive exPlanation (SHAP) values, and the clinical utility of predictive models using decision curve analysis (DCA). Results: The predictive model included the following variables: type 2 diabetes mellitus (T2DM), obesity, absolute neutrophil and basophil counts, the neutrophil-to-lymphocyte ratio (NLR), and D-dimer levels on the day of hospital admission. LR showed an Sn of 0.67, Sp of 0.65, AUC of 0.74, and P of 0.66. RF achieved an Sn of 0.87, Sp of 0.83, AUC of 0.96, and P of 0.85. XGBoost demonstrated an Sn of 0.87, Sp of 0.85, AUC of 0.95, and P of 0.86. Conclusions: Among the evaluated models, XGBoost showed robust predictive performance (Sn = 0.87, Sp = 0.85, AUC = 0.95, P = 0.86) and a favorable net clinical benefit in the decision curve analysis, confirming its suitability for predicting ICU admission in COVID-19 and aiding clinical decision-making.
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Affiliation(s)
- Alfonso Heriberto Hernández-Monsalves
- Laboratorio de Investigación en Salud de Precisión, Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco 4780000, Chile
| | - Pablo Letelier
- Laboratorio de Investigación en Salud de Precisión, Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco 4780000, Chile
| | - Camilo Morales
- Departamento de Procesos Terapéuticos, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco 4780000, Chile
| | - Eduardo Rojas
- Laboratorio de Investigación en Salud de Precisión, Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco 4780000, Chile
| | - Mauricio Alejandro Saez
- Laboratorio de Investigación en Salud de Precisión, Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco 4780000, Chile
| | - Nicolás Coña
- Laboratorio de Investigación en Salud de Precisión, Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco 4780000, Chile
| | - Javiera Díaz
- Laboratorio de Investigación en Salud de Precisión, Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco 4780000, Chile
| | - Andrés San Martín
- Laboratorio Clínico, Hospital Dr. Hernán Henríquez Aravena, Temuco 4780000, Chile
| | - Paola Garcés
- Centro Médico AlergoInmuno Araucanía, Temuco 4780000, Chile
| | - Jesús Espinal-Enriquez
- Computational Genomics Department, National Institute of Genomic Medicine, Mexico City 14610, Mexico
| | - Neftalí Guzmán
- Laboratorio de Investigación en Salud de Precisión, Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, Temuco 4780000, Chile
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13
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Kimura H, Hosozawa M, Taniguchi Y, Yamagishi K, Kitajima K, Terada M, Asai Y, Ohmagari N, Iso H. COVID-19-specific prefectural hospital bed utilization rate and in-hospital mortality among COVID-19 patients throughout the first three years of the pandemic in Japan. J Epidemiol 2025:JE20240395. [PMID: 40254429 DOI: 10.2188/jea.je20240395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2025] Open
Abstract
BACKGROUND We examined the association between the COVID-19-specific prefectural bed utilization rate and in-hospital mortality during the first three years of the pandemic in Japan. METHODS This nationwide study included 58,175 COVID-19 patients from the COVID-19 Registry Japan, hospitalized between May 1, 2020 and November 30, 2022. Based on the weekly COVID-19-specific bed utilization rate in each prefecture at diagnosis, patients were categorized into four groups (< 25%, 25% to < 50%, 50% to < 75%, and ≥ 75%). Odds ratios (ORs) were estimated by fitting a generalized linear mixed model with prefecture as a random intercept and adjusting for covariates (age, gender, body mass index, smoking and drinking status, and comorbidities). Additional analyses according to age group, gender, and wave of the pandemic were conducted. RESULTS We observed 2312 (4.0%) all-cause in-hospital deaths. All-cause in-hospital mortality increased with higher COVID-19 bed utilization rates at diagnosis (OR for multivariable model 1.35, 95% confidence interval [CI] 1.19-1.54 for 25% to <50%; 1.89, 1.66-2.16 for 50 to <75%; 2.16, 1.80-2.58 for ≥75%; P for trend<0.0001). Stronger associations were noted among the younger population (aged <70 years, OR: 3.18, 1.96-5.19) and during the fourth (March 1-June 30, 2021, OR: 3.81, 2.13-6.80) and sixth pandemic waves (January 1-Jun 30, 2022, OR: 2.67, 1.68-4.23). CONCLUSIONS Our results emphasize that preventing hospital bed shortages during outbreaks is an important public health strategy to reduce the associated mortality, particularly when new strains emerge and in younger people.
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Affiliation(s)
- Hitomi Kimura
- Institute for Global Health Policy Research, Japan Institute for Health Security
- Doctoral Program in Medical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Mariko Hosozawa
- Institute for Global Health Policy Research, Japan Institute for Health Security
| | - Yuta Taniguchi
- Institute for Global Health Policy Research, Japan Institute for Health Security
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba
- Department of Public Health, Juntendo University Graduate School of Medicine
| | - Koji Kitajima
- Center for Clinical Sciences, Japan Institute for Health Security
| | - Mari Terada
- Center for Clinical Sciences, Japan Institute for Health Security
- Disease Control and Prevention Center, Japan Institute for Health Security
| | - Yusuke Asai
- AMR Clinical Reference Center, Japan Institute for Health Security
| | - Norio Ohmagari
- Disease Control and Prevention Center, Japan Institute for Health Security
- AMR Clinical Reference Center, Japan Institute for Health Security
| | - Hiroyasu Iso
- Institute for Global Health Policy Research, Japan Institute for Health Security
- Department of Public Health Medicine, Institute of Medicine, and Health Services Research and Development Center, University of Tsukuba
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14
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Lana FCB, Marinho CC, de Paiva BBM, Valle LR, do Nascimento GF, da Rocha LCD, Carneiro M, Batista JDL, Anschau F, Paraiso PG, Bartolazzi F, Cimini CCR, Schwarzbold AV, Rios DRA, Gonçalves MA, Marcolino MS. Unraveling relevant cross-waves pattern drifts in patient-hospital risk factors among hospitalized COVID-19 patients using explainable machine learning methods. BMC Infect Dis 2025; 25:537. [PMID: 40234758 PMCID: PMC12001466 DOI: 10.1186/s12879-025-10766-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2024] [Accepted: 03/07/2025] [Indexed: 04/17/2025] Open
Abstract
BACKGROUND Several studies explored factors related to adverse clinical outcomes among COVID-19 patients but lacked analysis of the impact of the temporal data shifts on the strength of association between different predictors and adverse outcomes. This study aims to evaluate factors related to patients and hospitals in the prediction of in-hospital mortality, need for invasive mechanical ventilation (IMV), and intensive care unit (ICU) transfer throughout the pandemic waves. METHODS This multicenter retrospective cohort included COVID-19 patients from 39 hospitals, from March/2020 to August/2022. The pandemic was divided into waves: 10/03/2020-14/11/2020 (first), 15/11/2020-25/12/2021 (second), 26/12/2021-03/08/2022 (third). Patient-related factors included clinical, demographic, and laboratory data, while hospital-related factors covered funding sources, accreditation, academic status, and socioeconomic characteristics. Shapley additive explanation (SHAP) values derived from the predictions of a light gradient-boosting machine (LightGBM) model were used to assess potential risk factors for death, IMV and ICU. RESULTS Overall, 16,958 adult patients were included (median age 59 years, 54.7% men). LightGBM achieved competitive effectiveness metrics across all periods. Temporal drifts were observed due to a decrease in various metrics, such as the recall for the positive class [ICU: 0.4211 (wave 1) to 0.1951 (wave 3); IMV: 0.2089 (wave 1) to 0.0438 (wave 3); death: 0.2711 (wave 1) to 0.1175 (wave 3)]. Peripheral arterial oxygen saturation to the fraction of inspired oxygen ratio (SatO2/FiO2) at admission had great predictive capacity for all outcomes, with an optimal cut-off value for death prediction of 227.78. Lymphopenia had its association strength increased over time for all outcomes, optimal threshold for death prediction of 643 × 109/L. Thrombocytopenia was the most important feature in wave 2 (ICU); overall, values below 143,000 × 109/L were more related to death. CONCLUSION Data drifts were observed in all scenarios, affecting potential predictive capabilities of explainable machine learning methods. Upon admission, SatO2/FiO2 values, platelet and lymphocyte count were significant predictors of adverse outcomes in COVID-19 patients. Overall, inflammatory response markers were more important than clinical characteristics. Limitations included sample representativeness and confounding factors. Integrating the drift's knowledge into models to improve effectiveness is a challenge, requiring continuous updates and monitoring of performance in real-world applications. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
| | - Carolina Coimbra Marinho
- Department of Internal Medicine, Medical School & Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 110, Brazil
| | - Bruno Barbosa Miranda de Paiva
- Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Lucas Rocha Valle
- Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | | | | | - Marcelo Carneiro
- Hospital Santa Cruz. R. Fernando Abott, Santa Cruz do Sul, 174, Brazil
| | | | - Fernando Anschau
- Hospital Nossa Senhora da Conceição, Av. Francisco Trein, Porto Alegre, 326, Brazil
| | | | - Frederico Bartolazzi
- Hospital Santo Antônio, Praça Dr. Márcio Carvalho Lopes Filho, Curvelo, 501, Brazil
| | | | | | | | - Marcos André Gonçalves
- Computer Science Department, Universidade Federal de Minas Gerais, Av. Presidente Antônio Carlos, Belo Horizonte, 6627, Brazil
| | - Milena Soriano Marcolino
- Department of Internal Medicine, Medical School & Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Av. Professor Alfredo Balena, Belo Horizonte, 110, Brazil
- Institute for Health and Technology Assessment. R. Ramiro Barcelos, Porto Alegre, 2350, Brazil
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15
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Teles C, Borges A, Magalhães A, Barra C, Silva I, Tomé P, Crespo J, Paiva A, Santos L. Effectiveness and immunogenicity of SARS-CoV-2 booster vaccine in immunosuppressed systemic autoimmune disease patients: A prospective study. Med Clin (Barc) 2025; 164:106920. [PMID: 40220498 DOI: 10.1016/j.medcli.2025.106920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 01/13/2025] [Accepted: 01/16/2025] [Indexed: 04/14/2025]
Abstract
INTRODUCTION AND OBJECTIVES Patients with systemic autoimmune rheumatic disease (SARD) are a vulnerable population for severe COVID-19 and worse response to vaccination, prompting the need of a booster vaccine. Data regarding its response is limited and inconsistent. The aim of this study was to assess the effectiveness and immunogenicity of the third dose of the SARS-CoV-2 vaccine in immunosuppressed SARD patients. MATERIALS AND METHODS We conducted a prospective study in immunosuppressed SARD Portuguese patients, who received a SARS-CoV-2 booster vaccine, from October 2021 to August 2022. We evaluated COVID-19 incidence in the following 6 months, as well as vaccine immunogenicity through anti-Spike IgG titers and T-cell reactivity to the Spike protein. RESULTS We included 131 patients with a mean age of 54.9±12.2 years. Almost 40% (n=52) developed COVID-19 within 6 months after the booster, but 51 (98.1%) were mild infections. Median post-booster antibody levels and antibody variation were 9540.7 (14,724) and 8937.9 (11,561.3)AU/mL, respectively, and 73.3% (n=96) of the patients showed post-booster T-cell reactivity. Antibody variation was significantly lower in the COVID group (p=0.015). Although post-booster antibody levels and T-cell reactivity were statistically significantly lower in the patients under biologic DMARD, there was not a significant increase in COVID-19 incidence. CONCLUSIONS This study shows that a booster vaccine elicits strong immunogenicity and reduces COVID-19 severity, highlighting its importance in immunosuppressed SARD patients. Larger and more homogeneous cohorts are needed to guide periodic booster administration in this susceptible population.
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Affiliation(s)
- Carolina Teles
- Department of Internal Medicine, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal.
| | - Ana Borges
- Department of Internal Medicine, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Ana Magalhães
- Department of Internal Medicine, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Cátia Barra
- Department of Internal Medicine, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Isabel Silva
- Flow Cytometry Unit, Department of Clinical Pathology, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Patrícia Tomé
- Flow Cytometry Unit, Department of Clinical Pathology, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Jorge Crespo
- Department of Internal Medicine, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal
| | - Artur Paiva
- Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal; Flow Cytometry Unit, Department of Clinical Pathology, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal; Center for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
| | - Lèlita Santos
- Department of Internal Medicine, Unidade Local de Saúde de Coimbra, Praceta Professor Mota Pinto, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Coimbra, Portugal
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16
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Elling JM, Sänger N, Schwarz B, Seifert N, Hetzel C. Return to Work After Medical Rehabilitation for Musculoskeletal Disorders in Times of the COVID-19 Pandemic: A Retrospective Cohort Study. Arch Phys Med Rehabil 2025:S0003-9993(25)00627-6. [PMID: 40194735 DOI: 10.1016/j.apmr.2025.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 03/31/2025] [Accepted: 04/02/2025] [Indexed: 04/09/2025]
Abstract
OBJECTIVE To describe and explain the effect of the coronavirus disease 2019 pandemic and its related measures on return to work (RTW) outcomes after multimodal medical rehabilitation for musculoskeletal disorders. DESIGN Retrospective cohort study. SETTING Three cohorts: reference (rehabilitation and RTW prepandemic), pandemic 1 (rehabilitation prepandemic, RTW during pandemic), and pandemic 2 (rehabilitation and RTW during pandemic). PARTICIPANTS Individuals who underwent multimodal medical rehabilitation for musculoskeletal disorders through the German Pension Insurance system between January 2018 and December 2021 (N=688,127). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A successful and stable RTW was operationalized as having employment subject to social insurance contributions from 9 to 12 months after rehabilitation. RESULTS Descriptive analysis revealed an RTW rate of 67.2% in the reference cohort, a slight decline in pandemic cohort 1 (66.3%), and a more pronounced decrease in pandemic cohort 2 (63.1%). In contrast, average marginal predictions from a logistic model including various covariates showed that both pandemic cohorts (63.8% and 64.4%) exhibited similarly reduced predicted probabilities of RTW compared with the reference cohort (66.5%). Individuals with sick leave durations exceeding 6 months, compared with those with shorter sick leaves, were more negatively affected by pandemic cohort 1; however, this effect recovered in pandemic cohort 2. The interaction between cohort and income did not show any amplifying effect of the pandemic. CONCLUSIONS The logistic model revealed no differences in predicted probabilities of RTW between pandemic cohort 2 and pandemic cohort 1, suggesting that orthopedic rehabilitation remained robust in maintaining RTW outcomes despite pandemic-related challenges. The findings offer mixed evidence regarding the question of whether the pandemic amplified preexisting barriers to RTW.
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Affiliation(s)
- Jan Mathis Elling
- Institute for Quality Assurance in Prevention and Rehabilitation (IQPR),The German Sport University Cologne, Cologne.
| | - Nadine Sänger
- Institute for Quality Assurance in Prevention and Rehabilitation (IQPR),The German Sport University Cologne, Cologne
| | - Betje Schwarz
- Institute for Quality Assurance in Prevention and Rehabilitation (IQPR),The German Sport University Cologne, Cologne
| | - Nico Seifert
- Federal German Pension Insurance, Berlin, Germany
| | - Christian Hetzel
- Institute for Quality Assurance in Prevention and Rehabilitation (IQPR),The German Sport University Cologne, Cologne
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17
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Al-Saleh J, Rachidi W, Khan NA, Ahmed MG, Al-Saidi H, Zamani N, Elsidig NEE, Negm AA, Elbadawi F. Severe COVID-19 in Patients with Immune-Mediated Rheumatic Disorders: A Case-Control Study. Open Access Rheumatol 2025; 17:57-72. [PMID: 40226155 PMCID: PMC11986260 DOI: 10.2147/oarrr.s510631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Accepted: 04/01/2025] [Indexed: 04/15/2025] Open
Abstract
Purpose To assess the impact of severe COVID-19 in patients with immune-mediated rheumatic diseases (im-RD) and compare their morbidity, mortality, hospitalization issues, post-COVID-19 sequelae, and the financial burden of COVID-19 with those of patients without im-RD. Patients and Methods We conducted a retrospective case-control study that included 132 consecutive patients with im-RD who visited the Rheumatology Department of a public hospital in the Emirate of Dubai and were hospitalized for COVID-19 infection between March 1st, 2020, and December 31st, 2021, (cases). We included 264 and 132 age- and sex-matched patients without im-RD in matched-I and matched-II control groups, respectively. The median age of patients and controls was 48.5 years, and 74.2% were female. Patients with im-RD were paired with an unforced nearest neighbor match using a caliper width of 0.2 standard deviations of the matched-II control group's propensity score. We compared the relative risk of death, disease progress, use of medical resources, and financial impact of COVID-19 between patients and controls. Results Patients with im-RD had higher mortality rates than the matched-I (odds ratio, OR: 11.2, p < 0.000) and matched-II (OR: 16.8, p < 0.006) control groups. The overall complication rate was also significantly higher in patients with im-RD than in matched-I (OR = 2.9, p < 0.000) and matched-II (OR = 2.8, P < 0.0001) control groups. Lastly, patients with im-RD required more frequent visits to the clinic, a longer recovery time following hospital discharge, and increased healthcare costs compared to the control groups. Conclusion COVID-19 infection in patients with im-RD is associated with increased morbidity and mortality, exerting a significant burden on the healthcare system.
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Affiliation(s)
- Jamal Al-Saleh
- Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Wafae Rachidi
- Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates
- Department of Rheumatology, Faculty of Medicine, Hassan II University, Casablanca, Morocco
| | - Naureen Ali Khan
- Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Mohammed G Ahmed
- Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates
- Rheumatology Department, AL-Azhar University, Cairo, Egypt
| | - Hend Al-Saidi
- Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates
| | - Noura Zamani
- Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates
| | | | - Ahmed Abdelmoniem Negm
- Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates
- Rheumatology Department, AL-Azhar University, Cairo, Egypt
| | - Faisal Elbadawi
- Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates
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18
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Nassi‐Liberman O, Oberman B, Strahl T, Yosef N, Shlomi D. Association between obstructive sleep apnea (OSA) and COVID-19 severity. J Sleep Res 2025; 34:e14260. [PMID: 38867140 PMCID: PMC11911043 DOI: 10.1111/jsr.14260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/14/2024]
Abstract
Obstructive sleep apnea and sleep-related hypoxia have been associated with higher rates of hospitalization and mortality among patients with Coronavirus disease 2019 (COVID-19). We further explored the association between obstructive sleep apnea, COVID-19 severity and related mortality. In addition, we examined the effects of clinical and demographic parameters on COVID-19. In this retrospective study, we included adult patients who were diagnosed with COVID-19 prior to the Omicron variant identification. We compared the severity of COVID-19 and mortality with the diagnosis of obstructive sleep apnea. The study population included 44,275 patients who tested positive for COVID-19. Of these, 97% had mild or asymptomatic disease, 1.2% had moderate disease, and 1.8% had severe disease. Obstructive sleep apnea was diagnosed in 980 (2.2%) patients. In a multivariate analysis, obstructive sleep apnea diagnosis increased the risk of severe COVID-19 by 1.6 (95% confidence interval: 1.1-2.4) compared with mild disease. However, no increase in mortality was associated with obstructive sleep apnea. Interestingly, patients with moderate and high socioeconomic status had a 1.6 times higher risk for severe COVID-19 than patients from the low socioeconomic status group (95% confidence interval: 1.2-2.1 and 95% confidence interval: 1.1-2.3, respectively). The risk of dying due to COVID-19 was 1.6 (95% confidence interval: 1.1-2.5) and 3.1 (95% confidence interval: 1.8-5.3) times higher in patients with medium and high socioeconomic status, respectively, compared with patients with low socioeconomic status. Diagnosis of obstructive sleep apnea was found to be an independent risk factor for severe COVID-19. The higher the socioeconomic status, the higher the risk of severe COVID-19 morbidity and mortality.
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Affiliation(s)
| | - Bernice Oberman
- Research Unit, Dan‐ Petah‐Tiqwa DistrictClalit Health Services Community DivisionRamat‐GanIsrael
| | - Tamar Strahl
- Research Unit, Dan‐ Petah‐Tiqwa DistrictClalit Health Services Community DivisionRamat‐GanIsrael
| | - Noga Yosef
- Research Unit, Dan‐ Petah‐Tiqwa DistrictClalit Health Services Community DivisionRamat‐GanIsrael
| | - Dekel Shlomi
- Adelson School of MedicineAriel UniversityArielIsrael
- Pulmonary Clinic, Dan‐ Petah‐Tiqwa DistrictClalit Health Services Community DivisionRamat‐GanIsrael
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19
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Shimba R, Hanai S, Ito R, Tanaka-Mabuchi N, Maejima Y, Harai N, Tsuchiya K, Nakagomi D. Isolated adrenocorticotropic hormone deficiency manifested after COVID-19. J Infect Chemother 2025; 31:102635. [PMID: 39884431 DOI: 10.1016/j.jiac.2025.102635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 01/16/2025] [Accepted: 01/27/2025] [Indexed: 02/01/2025]
Abstract
Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 and long COVID can present with nonspecific symptoms resembling adrenal insufficiency. This similarity of symptoms means that adrenal insufficiency hidden among nonspecific manifestations of COVID-19 may pass underrecognized. We present the case of a 53-year-old Japanese man who developed isolated adrenocorticotrophic hormone (ACTH) deficiency (IAD) and acute adrenal insufficiency after COVID-19, thus mimicking prolonged symptoms of COVID-19. The patient developed fever, cough, and sore throat and was diagnosed with COVID-19. After anti-viral treatment, fever, loss of appetite, and general fatigue persisted, and hyponatremia was observed. Endocrinological testing on admission showed baseline concentrations of 3.5 μg/dL for cortisol and <1.5 pg/mL for ACTH. No abnormalities of other pituitary hormones were evident. Standard ACTH stimulation tests showed a decreased peak serum cortisol concentration and corticotropin-releasing hormone stimulation tests revealed no ACTH secretory response. Magnetic resonance imaging of the pituitary revealed no abnormalities. Adrenal insufficiency due to IAD was diagnosed based on the results of endocrinological testing. Intravenous and oral hydrocortisone improved symptoms and hyponatremia. The patient has experienced no recurrence of adrenal insufficiency under hydrocortisone treatment. COVID-19 can mimic adrenal insufficiency. IAD should be considered when nonspecific symptoms persist after treatment for COVID-19.
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Affiliation(s)
- Ryo Shimba
- Department of Diabetes and Endocrinology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Shunichiro Hanai
- Department of Rheumatology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Ryosuke Ito
- Department of Rheumatology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Nakako Tanaka-Mabuchi
- Department of Rheumatology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Yu Maejima
- Department of Diabetes and Endocrinology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Nozomi Harai
- Department of Diabetes and Endocrinology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Kyoichiro Tsuchiya
- Department of Diabetes and Endocrinology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
| | - Daiki Nakagomi
- Department of Rheumatology, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
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20
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Xie X, Zhang Y, Fang Y, Wu J, Li Q. Molecular Basis of High-Blood-Pressure-Enhanced and High-Fever-Temperature-Weakened Receptor-Binding Domain/Peptidase Domain Binding: A Molecular Dynamics Simulation Study. Int J Mol Sci 2025; 26:3250. [PMID: 40244099 PMCID: PMC11989460 DOI: 10.3390/ijms26073250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Revised: 03/21/2025] [Accepted: 03/30/2025] [Indexed: 04/18/2025] Open
Abstract
The entry and infection of the Severe Acute Respiratory Syndrome Coronavirus 2 virus (SARS-CoV-2) involve recognition and binding of the receptor-binding domain (RBD) of the virus surface spike protein to the peptidase domain (PD) of the host cellular Angiotensin-Converting Enzyme-2 (ACE2) receptor. ACE2 is also involved in normal blood pressure control. An association between hypertension and COVID-19 severity and fatality is evident, but how hypertension predisposes patients diagnosed with COVID-19 to unfavorable outcomes remains unclear. High temperature early during SARS-CoV-2 infection impairs binding to human cells and retards viral progression. Low body temperature can prelude poor prognosis. In this study, all-atom molecular dynamics simulations were performed to examine the effects of high pressure and temperature on RBD/PD binding. A high blood pressure of 940 mmHg enhanced RBD/PD binding. A high temperature above 315 K significantly weakened RBD/PD binding, while a low temperature of 305 K enhanced binding. The curvature of the PD α1-helix and proximity of the PD β3β4-hairpin tip to the RBM motif affected the compactness of the binding interface and, hence, binding affinity. These findings provide novel insights into the underlying mechanisms by which hypertension predisposes patients to unfavorable outcomes in COVID-19 and how an initial high temperature retards viral progression.
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Affiliation(s)
| | | | | | - Jianhua Wu
- Institute of Biomechanics, School of Biology and Biological Engineering, South China University of Technology, Guangzhou Higher Education Mega Centre, Panyu District, Guangzhou 510006, China; (X.X.); (Y.Z.); (Y.F.)
| | - Quhuan Li
- Institute of Biomechanics, School of Biology and Biological Engineering, South China University of Technology, Guangzhou Higher Education Mega Centre, Panyu District, Guangzhou 510006, China; (X.X.); (Y.Z.); (Y.F.)
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21
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Guillén-Teruel A, Mellina-Andreu JL, Reina G, González-Billalabeitia E, Rodriguez-Iborra R, Palma J, Botía JA, Cisterna-García A. Identifying risk factors and predicting long COVID in a Spanish cohort. Sci Rep 2025; 15:10758. [PMID: 40155409 PMCID: PMC11953293 DOI: 10.1038/s41598-025-94765-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2024] [Accepted: 03/17/2025] [Indexed: 04/01/2025] Open
Abstract
Many studies have investigated symptoms, comorbidities, demographic factors, and vaccine effects in relation to long COVID (LC-19) across global populations. However, a number of these studies have shortcomings, such as inadequate LC-19 categorisation, lack of sex disaggregation, or a narrow focus on certain risk factors like symptoms or comorbidities alone. We address these gaps by investigating the demographic factors, comorbidities, and symptoms present during the acute phase of primary COVID-19 infection among patients with LC-19 and comparing them to typical non-Long COVID-19 patients. Additionally, we assess the impact of COVID-19 vaccination on these patients. Drawing on data from the Regional Health System of the Region of Murcia in southeastern Spain, our analysis includes comprehensive information from clinical and hospitalisation records, symptoms, and vaccination details of over 675126 patients across 10 hospitals. We calculated age and sex-adjusted odds ratios (AOR) to identify protective and risk factors for LC-19. Our findings reveal distinct symptomatology, comorbidity patterns, and demographic characteristics among patients with LC-19 versus those with typical non-Long COVID-19. Factors such as age, female sex (AOR = 1.39, adjusted p < 0.001), and symptoms like chest pain (AOR > 1.55, adjusted p < 0.001) or hyposmia (AOR > 1.5, adjusted p < 0.001) significantly increase the risk of developing LC-19. However, vaccination demonstrates a strong protective effect, with vaccinated individuals having a markedly lower risk (AOR = 0.10, adjusted p < 0.001), highlighting the importance of vaccination in reducing LC-19 susceptibility. Interestingly, symptoms and comorbidities show no significant differences when disaggregated by type of LC-19 patient. Vaccination before infection is the most important factor and notably decreases the likelihood of long COVID. Particularly, mRNA vaccines offer more protection against developing LC-19 than viral vector-based vaccines (AOR = 0.48). Additionally, we have developed a model to predict LC-19 that incorporates all studied risk factors, achieving a balanced accuracy of 73% and ROC-AUC of 0.80. This model is available as a free online LC-19 calculator, accessible at ( LC-19 Calculator ).
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Affiliation(s)
- Antonio Guillén-Teruel
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain
| | - Jose L Mellina-Andreu
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain
| | - Gabriel Reina
- Servicio de Microbiología, Clínica, Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain
| | | | - Ramón Rodriguez-Iborra
- Subdirección General de Tecnologías de la Información, Servicio Murciano de Salud, Murcia, Spain
| | - José Palma
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain
| | - Juan A Botía
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain
| | - Alejandro Cisterna-García
- Department of Information and Communication Engineering, University of Murcia, Murcia, 30100, Spain.
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22
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Vicencio VV, Viengkham C, Grange N, Norton S, Shaban RZ. COVID-19 outbreak management in Western Sydney residential aged care homes: A mixed-methods Donabedian evaluation. PLoS One 2025; 20:e0318490. [PMID: 40112010 PMCID: PMC11925308 DOI: 10.1371/journal.pone.0318490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 01/16/2025] [Indexed: 03/22/2025] Open
Abstract
Outbreaks of the novel respiratory viral disease, SARS-CoV-2 (COVID-19), have caused disproportionate morbidity and mortality for older people living in residential aged care homes. Between June 2021 and December 2022, the Delta and Omicron variants of COVID-19 were responsible for widespread outbreaks in homes across Western Sydney, New South Wales, Australia. To manage outbreaks in affected homes, a targeted response strategy was prepared and deployed in the form of outbreak management teams. This study utilised the Donabedian framework and a two-phase mixed methods design to evaluate the structures, processes and outcomes of the outbreak management teams at the level of the local health district. Phase 1 involved the descriptive analysis of outbreak data from Western Sydney aged care homes, created between June 2021 and December 2022. Phase 2 involved the completion of in-depth semi-structured interviews with 35 participants to explore the outbreak management team response from the perspective of its members and staff from residential aged care homes. Between June 2021 and December 2022, there were 281 outbreaks, 4113 resident cases, 346 hospitalisations and 127 deaths in residential aged care homes across Western Sydney. Structural factors that facilitated the outbreak management response and improved outcomes included smaller home sizes, the absence of shared rooms and bathrooms, adequate staffing and resources, suitable infrastructure, and the integration of the response with wider public health systems. Process facilitators included multi-disciplinary team membership, open communication channels, structured and streamlined procedures and roles, onsite infection control support and education, and long-term capability building. The lessons drawn from participants' experiences aim to improve the outcomes and sustainability of current and future outbreak management strategies.
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Affiliation(s)
- Vincent V. Vicencio
- Population and Community Health, South Eastern Sydney Local Health District, Taren Point, New South Wales, Australia
| | - Catherine Viengkham
- Sydney Infectious Diseases Institute, Faculty of Health and Medicine, University of Sydney, Taren Point, New South Wales, Australia
- Research and Education Network, Western Sydney Local Health District, North Parramatta, New South Wales, Australia
| | | | - Sophie Norton
- New South Wales Biocontainment Centre, NSW High Consequence Infectious Disease Specialist Service, North Parramatta, New South Wales, Australia
| | - Ramon Z. Shaban
- Sydney Infectious Diseases Institute, Faculty of Health and Medicine, University of Sydney, Taren Point, New South Wales, Australia
- Research and Education Network, Western Sydney Local Health District, North Parramatta, New South Wales, Australia
- New South Wales Biocontainment Centre, NSW High Consequence Infectious Disease Specialist Service, North Parramatta, New South Wales, Australia
- Centre for Population Health, Western Sydney Local Health District, New South Wales, Australia
- Susan Wakil School of Nursing and Midwifery, Faculty of Health and Medicine, University of Sydney, Taren Point, New South Wales, Australia
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23
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Suwanai H, Kanda M, Harada K, Ishii K, Iwasaki H, Hara N, Kobayashi Y, Matsumura H, Inoue T, Suzuki R. Diabetes with COVID-19 was a significant risk factor for mortality, mechanical ventilation, and renal replacement therapies: A multicenter retrospective study in Japan. PLoS One 2025; 20:e0319801. [PMID: 40106491 PMCID: PMC11922262 DOI: 10.1371/journal.pone.0319801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 02/07/2025] [Indexed: 03/22/2025] Open
Abstract
We conducted a multicenter retrospective cohort study across 38 hospitals in Chiba, Japan, between February 1, 2020 and November 31, 2021 to investigate the effect of coronavirus disease 2019 (COVID-19) on patients with diabetes mellitus receiving inpatient care. We collected inpatient medical data through Diagnosis procedure combination (DPC), the diagnoses and payment system of medical insurance, from each hospital. We excluded patients younger than 18 years, those who were pregnant, and those who had diabetes but were not treated with diabetic medication. A total of 10,776 patients were included: 7,679 in the non-diabetic (control) group and 3,097 in the diabetic group. Patients in the diabetic group were older and had a higher body mass index (BMI) than those in the control group. In the diabetes group, 88.4% of the patients were treated with insulin therapy and 44.2% were treated with oral hypoglycemic agents. The length of hospital days was significantly longer in the diabetes group. The in-hospital mortality rate was significantly higher especially between 50 and 59 years old. The rates of in-hospital mortality, mechanical ventilation, intensive care unit (ICU) admission, renal replacement therapies such as hemodialysis (HD), and continuous hemodiafiltration (CHDF) were all higher, even after adjusting for age, sex, BMI, and ambulance use. In conclusion, diabetes was a significant risk factor of the severe clinical outcomes especially for in-hospital mortality, mechanical ventilation usage, ICU admission, HD, and CHDF in Japan.
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Affiliation(s)
- Hirotsugu Suwanai
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University, Tokyo, Japan
| | - Masato Kanda
- Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
- Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan
| | - Kazuharu Harada
- Department of Health Data Science, Tokyo Medical University, Tokyo, Japan
| | - Keitaro Ishii
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University, Tokyo, Japan
| | - Hajime Iwasaki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University, Tokyo, Japan
| | - Natsuko Hara
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University, Tokyo, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Matsumura
- Department of Plastic and Reconstructive Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takahiro Inoue
- Healthcare Management Research Center, Chiba University Hospital, Chiba, Japan
| | - Ryo Suzuki
- Department of Diabetes, Metabolism, and Endocrinology, Tokyo Medical University, Tokyo, Japan
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24
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Ozgun Niksarlioglu EY, Uysal MA, Seyhan EC, Kıyık M, Çetinkaya E. Hypersensitivity pneumonitis in Covid-19: mortality, risk factors, and clinical outcomes from a 30-case observational study. SARCOIDOSIS, VASCULITIS, AND DIFFUSE LUNG DISEASES : OFFICIAL JOURNAL OF WASOG 2025; 42:16163. [PMID: 40100115 PMCID: PMC12013693 DOI: 10.36141/svdld.v42i1.16163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/13/2024] [Indexed: 03/20/2025]
Affiliation(s)
- Elif Yelda Ozgun Niksarlioglu
- Health Science University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Mehmet Atilla Uysal
- Health Science University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Ekrem Cengiz Seyhan
- Health Science University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Murat Kıyık
- Health Science University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
| | - Erdoğan Çetinkaya
- Health Science University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Chest Diseases, Istanbul, Turkey
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Cheta N, Zakaria D, Demers A, Abdullah P, Aziz S. Association between pre-existing chronic conditions and severity of first SARS-CoV-2 infection symptoms among adults living in Canada: a population-based survey analysis from January 2020 to August 2022. BMC Public Health 2025; 25:981. [PMID: 40075342 PMCID: PMC11905645 DOI: 10.1186/s12889-025-22041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Accepted: 02/20/2025] [Indexed: 03/14/2025] Open
Abstract
BACKGROUND Individuals living with chronic conditions (CC) typically have a higher risk of more severe outcomes when exposed to infection. Although many studies have investigated the relationship between CCs and COVID-19 severity, they are generally limited to clinical or hospitalized populations. There is a need to estimate the impact of pre-existing CCs on the severity of acute SARS-CoV-2 infection symptoms among the general population. METHODS Data from the Canadian COVID-19 Antibody and Health Survey - Cycle 2, a population-based cross-sectional probability survey across 10 provinces capturing the COVID-19 experiences of respondents from January 2020 to August 2022, were used to assess whether pre-existing CCs increased the odds of more severe self-reported infection symptoms among adults living in Canada. Multivariable regression modelling identified which CCs were independently associated with more severe infection symptoms after adjusting for sex, age at infection, and other significant covariates. RESULTS Chronic lung disease (aOR = 1.64, 95% CI: 1.09, 2.46), high blood pressure (aOR = 1.35, 95% CI: 1.13, 1.62), weakened immune system (aOR = 1.46, 95% CI: 1.08, 1.98), chronic fatigue syndrome or fibromyalgia (aOR = 2.20, 95% CI: 1.39, 3.50), and arthritis (aOR = 1.28, 95% CI: 1.04, 1.56) were associated with a higher odds of more severe infection, whereas osteoporosis (aOR = 0.58, 95% CI: 0.39, 0.87) was associated with a lower odds. Limiting modelling to adults with confirmed SARS-CoV-2 infections affected some of the variables retained and adjusted associations. CONCLUSION Our findings contribute to a growing evidence base of associations between pre-existing CCs and adverse outcomes after SARS-CoV-2 infection. Identifying factors associated with more severe infection allows for more targeted prevention strategies and early interventions that can minimize the impact of infection.
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Affiliation(s)
- Nicholas Cheta
- Lifespan Chronic Diseases and Conditions Division (LCDC), Centre for Surveillance and Applied Research (CSAR), Health Promotion and Chronic Disease Prevention Branch (HPCDP), Public Health Agency of Canada (PHAC), Ottawa, ON, Canada.
| | - Dianne Zakaria
- Lifespan Chronic Diseases and Conditions Division (LCDC), Centre for Surveillance and Applied Research (CSAR), Health Promotion and Chronic Disease Prevention Branch (HPCDP), Public Health Agency of Canada (PHAC), Ottawa, ON, Canada
| | - Alain Demers
- Lifespan Chronic Diseases and Conditions Division (LCDC), Centre for Surveillance and Applied Research (CSAR), Health Promotion and Chronic Disease Prevention Branch (HPCDP), Public Health Agency of Canada (PHAC), Ottawa, ON, Canada
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Peri Abdullah
- Lifespan Chronic Diseases and Conditions Division (LCDC), Centre for Surveillance and Applied Research (CSAR), Health Promotion and Chronic Disease Prevention Branch (HPCDP), Public Health Agency of Canada (PHAC), Ottawa, ON, Canada
| | - Samina Aziz
- Lifespan Chronic Diseases and Conditions Division (LCDC), Centre for Surveillance and Applied Research (CSAR), Health Promotion and Chronic Disease Prevention Branch (HPCDP), Public Health Agency of Canada (PHAC), Ottawa, ON, Canada
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Freire APCF, Foch E, Medina BAS, Uzeloto JS, Leite MR, de Alencar Silva BS, Okoshi MP, Pacagnelli FL. Impact of the COVID-19 pandemic on tobacco product consumption and behavioral patterns from a low-middle income country perspective: A qualitative study. Tob Prev Cessat 2025; 11:TPC-11-16. [PMID: 40078935 PMCID: PMC11898110 DOI: 10.18332/tpc/201442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 02/13/2025] [Accepted: 02/16/2025] [Indexed: 03/14/2025]
Abstract
INTRODUCTION Previous studies investigating socioeconomic status and tobacco consumption during the COVID-19 pandemic were survey-based. To extend knowledge beyond prevalence rates and trends of tobacco consumption, qualitative research is needed to identify individual's experiences. There is a critical gap within this context, particularly in low-middle income countries. The aim of the study was to perform a qualitative analysis on consumption patterns of tobacco users from a low-middle income country during the COVID-19 pandemic, and to identify factors influencing motivation to quit tobacco products during the pandemic and the perceptions of self-risk for complications of tobacco consumption and COVID-19. METHODS A qualitative study was conducted in São Paulo, Brazil in September 2020. We used a focus group with semi-structured interviews. Participants were invited to answer questions about behavioral and consumption patterns of tobacco products during early stages of COVID-19 pandemic. Two investigators independently performed triangulation of content of the transcripts. Data were analyzed using inductive content analysis. RESULTS Eighteen participants were evaluated (66.7% males) with mean age 34.1 ± 14.9 years. Many participants presented high levels (33.3%) of nicotine dependence. Thematic analysis of participants' narratives resulted in two themes: Theme 1: Behavioral and psychological factors impacting consumption; and Theme 2: Consumption patterns, dependence, and information. Open-coding process resulted on four codes: 1) Behavioral and lifestyle changes; 2) Psychological and motivational factors; 3) Consumption patterns and dependence; and 4) Information exposure and awareness. Nine categories were generated from the codes. CONCLUSIONS Behavioral and consumption patterns varied significantly in tobacco users in Brazil during the early stages of the COVID-19 pandemic, ranging from increases to no changes. Individuals consuming tobacco products showed awareness about the harmful effects of smoking and COVID-19 complications.
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Affiliation(s)
| | - Eric Foch
- Department of Health Sciences, Central Washington University, Ellensburg, United States
| | | | - Juliana Souza Uzeloto
- Department of Physiotherapy, Educational Foundation of the Municipality of Assis, Assis, Brazil
| | | | | | - Marina Politi Okoshi
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University, Botucatu, Brazil
| | - Francis Lopes Pacagnelli
- Department of Physiotherapy, University of Western São Paulo, Presidente Prudente, Brazil
- Núcleo de Avaliação de Tecnologias em Saúde da Faculdade Medicina da Universidade do Oeste Paulista, São Paulo, Brazil
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Barberán J, Ramos M, Villanueva J, Villares P, Villareal M, Vivas M, Orche S, Tejera-Gonzalez M, Menéndez JM, Hinojosa LT, Almirall C, Antolin L, Martinez L, Mendoza S, Pelaez A, Segarra-Cañamares M, Guerrero JE, Pelaez J, Cardinal-Fernández P. Epidemiology of the COVID-19 pneumonia in a group of hospitals from Madrid-Spain during the full period of the State of Alarm HM cohort. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2025; 38:97-107. [PMID: 39950446 PMCID: PMC11894567 DOI: 10.37201/req/110.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 01/16/2025] [Indexed: 03/08/2025]
Abstract
INTRODUCTION To describe the epidemiology pattern of the COVID-19 pandemic during all Spanish State of Alarm. METHODS Retrospective, observational, cohort and multicenter study. Inclusion criteria: age ≥18 years old, admitted for COVID-19 pneumonia in any of the centers of the HM Hospitals Group. Exclusion criteria: voluntary discharge, death in the emergency department, transfer to centers outside the HM group or incomplete data. State of Alarm period: 31/01/2020 to 05/07/2023. Predominant COVID-19 variant was defined when it exceeded 50% of the total isolates. RESULTS During the study period, 2,992 patients were admitted due to a COVID-19 pneumonia, 295 patients (9.86%) non-survive. Survivors and non-survivors were different in age and comorbidities. However, both cohorts presented a similar net of interaction between comorbidities. Hospital admissions per week showed an evolution in "peaks" with "troughs". A total of 197 (6.48%) patients were admitted to the ICU, of whom 52 (26.39%) non-survive; this subgroup stood out for having a higher proportion of septic shock, orotracheal intubation and acute renal failure, as well as a lower proportion of pulmonary thromboembolism and delirium. Concerning the viral variants, the incidence for the original variant was 4.05 cases/day, for the alpha variant 3.82 cases/day, for the delta variant 1.16 cases/day and for the omicron variant 1.35 cases/day. CONCLUSION Almost 1 of 10 patients with COVID-19 pneumonia death, a proportion that increased to 1 of 4 in case of being admitted to the ICU. Unexpectedly, interaction between comorbidities did not differ between survivors and non-survivors patients. Predominant variants were associated with different hospital admission rates but not influence the presence of peak-troughs evolution of the pandemic.
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Affiliation(s)
- José Barberán
- Hospital Universitario HM Monteprincipe, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain
| | - María Ramos
- Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Julio Villanueva
- Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Paula Villares
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Mercedes Villareal
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Torrelodones, Madrid, Spain
| | - María Vivas
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Torrelodones, Madrid, Spain
| | - Susana Orche
- Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Madrid, Madrid, Spain
| | - María Tejera-Gonzalez
- Hospital Universitario HM Monteprincipe, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Torrelodones, Madrid, Spain
| | - Justo M Menéndez
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Lenin Tolentino Hinojosa
- Hospital Universitario HM Torrelodones, Madrid, Spain; Hospital Nacional Ramiro Prialé Huancayo, Perú
| | - Cristina Almirall
- Hospital Universitario HM Sanchinarro, Madrid, Spain; Laboratorio de análisis clínicos ABACID, Madrid, Spain
| | - Leonor Antolin
- Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Lady Martinez
- Hospital Universitario HM Monteprincipe, Madrid, Spain; Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain
| | - Silvia Mendoza
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Hospital Universitario HM Torrelodones, Madrid, Spain
| | - Adrián Pelaez
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain
| | | | - José E Guerrero
- Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Torrelodones, Madrid, Spain; Unidad de Cuidados Intensivos del Hospital Universitario "Gregorio Marañón", Madrid, Spain
| | - Jesús Pelaez
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Torrelodones, Madrid, Spain
| | - Pablo Cardinal-Fernández
- Facultad HM de Ciencias de la Salud, Universidad Camilo José Cela, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain; Hospital Universitario HM Torrelodones, Madrid, Spain.
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Sines B, Morrison CB, Donaldson JM, Ahmad A, Krishnamurthy A, Peden DB, Ehre C. Asthma and COVID-19: Unveiling Outcome Disparities and Treatment Impact Based on Distinct Endotypes. Ann Am Thorac Soc 2025; 22:339-349. [PMID: 39499775 PMCID: PMC11892659 DOI: 10.1513/annalsats.202405-507oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 11/05/2024] [Indexed: 11/07/2024] Open
Abstract
Rationale: Epidemiologic studies on patients with asthma and in vitro data suggest a protective role of type 2 (T2) inflammation in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objectives: Using a large, multisite cohort, we studied clinical outcomes after SARS-CoV-2 infection in multiple asthma endotypes and examined the effects of T2-directed biologics in infected patients with asthma. Methods: The National COVID Cohort Collaborative Data Enclave was used to identify and stratify patients with asthma by endotype to include those with non-T2 and T2 asthma, as well as exposure to T2-directed biologic therapy. We evaluated the risk of hospitalization, invasive mechanical ventilation, and 90-day mortality by endotype and exposure to biologics. Results: For this study, 402,376 patients met the inclusion criteria, of whom 138,142 (34%) were characterized as having non-T2 asthma and 264,234 (66%) as having T2 asthma, a group further divided into 104,823 (26%) atopic, 84,440 (21%) eosinophilic, and 74,971 (19%) T2-high asthmatic endotypes. Compared with patients with non-T2 asthma, those with atopic and T2-high asthma experienced decreased odds of hospitalization and 90-day mortality. Conversely, patients with eosinophilic asthma experienced higher odds of hospitalization, intubation, and 90-day mortality. Exposure to T2-directed biologic therapies did not alter outcomes after propensity score matching. In contrast, maximum eosinophil count and recent systemic corticosteroid use were directly correlated with increased odds of all outcomes. Conclusions: Coronavirus disease (COVID-19) outcomes differ depending on asthma endotype, with patients with atopic asthma experiencing lower odds and those with eosinophilic asthma experiencing higher odds of deleterious outcomes. T2-directed biologic treatment did not alter these outcomes, but recent systemic corticosteroid use predisposes all patients with asthma to adverse outcomes.
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Affiliation(s)
| | | | | | | | | | - David B. Peden
- Department of Pediatrics
- Center for Environmental Medicine, Asthma and Lung Biology, and
| | - Camille Ehre
- Marsico Lung Institute
- Center for Environmental Medicine, Asthma and Lung Biology, and
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Hinojosa-Gutiérrez LR, González-Sánchez AL, Rios-Muñoz JA, Aguilar-Guerrero R, Macías-Cervantes HE. Visceral fat as the main tomographic risk factor for COVID-19 mortality. Heart Lung 2025; 70:191-196. [PMID: 39705967 DOI: 10.1016/j.hrtlng.2024.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 12/03/2024] [Accepted: 12/06/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Obesity is a risk factor for COVID-19 mortality; a BMI >35 increases the risk of death up to 12-fold; two previous studies have examined the association between visceral fat quantified by tomography and the risk of severe COVID-19, but not its association with mortality. OBJECTIVE Examine whether tomographic findings differentiated data from patients who died of COVID-19 pneumonia from those who survived in a cohort of patients at a tertiary hospital. METHODS This was a case-control study (1:1) in which we recruited data from patients at a tertiary care hospital in Mexico. Cases (N = 213) were data from patients with COVID-19 pneumonia discharged due to death, and controls (N = 216) were data from patients discharged due to improvement. All had chest computed tomography (CT) scans in the Picture Archiving and Communication System (PACS) platform. Multivariate analysis was used to identify tomographic variables associated with mortality, and odds ratios were calculated. As tomographic variables, we refer to the total severity score, the total percentage of pulmonary involvement, the pattern of involvement, the location of the lesions, and subcutaneous and visceral fat. RESULTS A total of 429 sets of data from Mexican patients were analyzed, with an overall age of 57 years (18-93). Sixty-three percent were male, and arterial hypertension was the most common comorbidity in 48.3 %. An odds ratio (OR) of 8.79 (95 % CI 1.44-53.73) was found for visceral fat and mortality; the rest of the tomographic variables did not show a statistically significant association. CONCLUSION Visceral fat was the most significant tomographic risk factor for mortality in patients with COVID-19 pneumonia.
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Affiliation(s)
- Luis Ricardo Hinojosa-Gutiérrez
- Radiology Physician, Radiology Departament, Unidad Medica de Alta Especialidad, Hospital de Especialidades No 1, Centro Médico Nacional del Bajío, Boulevard Adolfo López Mateos esquina Insurgentes S/N, Colonia Los Paraísos, CP 37260, León, Guanajuato, Mexico.
| | - Adriana Lizbeth González-Sánchez
- Radiology Physician, Radiology Departament, Unidad Medica de Alta Especialidad, Hospital de Especialidades No 1, Centro Médico Nacional del Bajío, Boulevard Adolfo López Mateos esquina Insurgentes S/N, Colonia Los Paraísos, CP 37260, León, Guanajuato, Mexico.
| | - Jair Antonio Rios-Muñoz
- Radiology Physician, Radiology Departament, Unidad Medica de Alta Especialidad, Hospital de Especialidades No 1, Centro Médico Nacional del Bajío, Boulevard Adolfo López Mateos esquina Insurgentes S/N, Colonia Los Paraísos, CP 37260, León, Guanajuato, Mexico.
| | - Rodolfo Aguilar-Guerrero
- Internal Medicina Physician, Internal Medicine Department, Unidad Medica de Alta Especialidad, Hospital de Especialidades No 1, Centro Médico Nacional del Bajío, Boulevard Adolfo López Mateos esquina Insurgentes S/N, Colonia Los Paraísos, CP 37260, León, Guanajuato, Mexico.
| | - Hilda Elizabeth Macías-Cervantes
- Internal Medicina Physician, Internal Medicine Department, Unidad Medica de Alta Especialidad, Hospital de Especialidades No 1, Centro Médico Nacional del Bajío, Boulevard Adolfo López Mateos esquina Insurgentes S/N, Colonia Los Paraísos, CP 37260, León, Guanajuato, Mexico.
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Gómez-Mesa JE, Arango-Ibanez JP, Perel P, Prabhakaran D, León-Giraldo HO, Toro-Pedroza A, Gómez REL, Herrera CJ, Lugo-Peña J, Alaz LPC, Rossel V, Sierra-Lara D, Mercedes J, Saldarriaga-Giraldo CI, Rodríguez-González MJ, Alvarado A, Ortega JC, Da Silva MQ, Singh K, Sliwa K, On behalf of the CARDIO COVID 19–20 and WHF CVD COVID-19 research groups. Marked Global Differences in Mortality in Male Patients with COVID-19: An Analysis of the CARDIO COVID 19-20 and WHF COVID-19 CVD Studies. Glob Heart 2025; 20:21. [PMID: 40026348 PMCID: PMC11869830 DOI: 10.5334/gh.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Accepted: 02/11/2025] [Indexed: 03/05/2025] Open
Abstract
Background COVID-19 has led to nearly seven million deaths and male sex has been reported as one of the main risk factors for mortality. Few studies have analyzed cohorts of male patients, especially in underrepresented regions in the medical literature, such as low and middle-income nations. To address this gap, we conducted large-scale, male-specific, multinational analyses, to improve understanding of factors associated with mortality in this high-risk population and global variations. Methods This is a prospective, multicenter study that includes data from the CARDIO COVID-19-20 registry and the WHF COVID-19 CVD study. A multiple Poisson regression model was performed to evaluate differences in factors associated with in-hospital mortality among male COVID-19 patients across different regions. Results We analyzed 4,899 hospitalized male COVID-19 patients from 32 countries: Africa (11.2%), the Americas (44.7%), Asia (33.8%), and Europe (10.2%). Median age was 59 years (IQR: 47-69), with 50.5% aged 40-64. ICU admission was 42.4%, and mortality was 19.2%, with marked regional differences (ranging from 6% in Europe to 26.9% in the Americas). Poisson regression showed age >80 years (aRR = 4.21) and IMV (aRR = 3.80) as the strongest factors associated with mortality. Other factors included diabetes, chronic kidney disease, myocarditis, and decompensated heart failure. Mortality risk was higher in Africa (aRR = 3.86), Asia (aRR = 2.72), and the Americas (aRR = 2.23) compared to Europe (p < 0.001). Anticoagulation/Antiplatelet therapy showed a potential correlation with survival. Conclusion This study reflects the complexity of factors influencing COVID-19 mortality among male patients hospitalized with COVID-19, emphasizing global variability. The substantial differences in mortality noted across countries are likely due to differences in disease severity, comorbidities, clinical care, and health system factors. Age remains a primary risk factor, with older populations particularly vulnerable. Our findings underscore the need for targeted and tailored regional approaches to manage male COVID-19 patients.
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Affiliation(s)
- Juan Esteban Gómez-Mesa
- Departamento de Cardiología, Fundación Valle del Lili, Cali, Colombia
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Juan Pablo Arango-Ibanez
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | - Pablo Perel
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, World Heart Federation, Switzerland
| | - Dorairaj Prabhakaran
- Public Health Foundation India, Centre for Chronic Disease Control, World Heart Federation, London School of Hygiene & Tropical Medicine, UK
| | - Hoover O. León-Giraldo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | | | | | - César J. Herrera
- Departamento de Cardiología, Centros de Diagnóstico y Medicina Avanzada y de Conferencias Médicas y Telemedicina (CEDIMAT), Santo Domingo, Dominican Republic
| | - Julián Lugo-Peña
- Departamento de Cardiología, Centro de Diagnóstico, Medicina Avanzada y Telemedicina (CEDIMAT), Santo Domingo, República Dominicana
| | | | - Victor Rossel
- Departamento de Cardiología, Hospital del Salvador, Santiago de Chile, Chile
- Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Daniel Sierra-Lara
- Departamento de Cardiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Jessica Mercedes
- Departamento de Cardiología, Hospital Nacional San Rafael, Santa Tecla, El Salvador
| | | | | | | | - Juan Carlos Ortega
- Departamento de Cardiología, Hospital Universitario Erasmo Meoz, Cúcuta, Colombia
| | | | - Kavita Singh
- Public Health Foundation of India, Gurugram, Haryana, India
- Centre for Chronic Disease Control, New Delhi, India
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine & Cardiology, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa, World Heart Federation, Switzerland
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Palus D, Gołębiewska M, Piątek-Dalewska O, Grudziński K, Kuziemski K, Owczuk R, Hoffmann M, Kozłowski D, Stefaniak T. Association of pre-existing comorbidities and complications with inpatient COVID-19 mortality - a single-center retrospective study. Cardiol J 2025; 32:120-129. [PMID: 39998404 PMCID: PMC12068236 DOI: 10.5603/cj.103122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 01/24/2025] [Indexed: 02/26/2025] Open
Abstract
BACKGROUND This study evaluates the impact of pre-existing comorbidities and in-hospital complications on COVID-19 mortality rates. METHODS A retrospective single-center study was conducted using electronic health records from 640 COVID-19 patients hospitalized at the University Clinical Centre in Gdansk, Poland, between November 2020 and May 2021. Patients were categorized based on disease severity into stable or ICU wards based on the disease severity. Data on demographics, comorbidities, complications, and treatments were collected and verified. Statistical analyses, including odds ratios (ORs) and confidence intervals (CIs), assessed mortality risk factors supported by python-based processing. RESULTS The mean patient age was 67 years (SD ± 15.89), comprising 39% females (n = 250) and 60.94% males (n = 390). Mortality risk was highest in patients aged 65 years and older (OR 3.00; 95% CI, 1.97-4.60). Among the pre-existing comorbidities, chronic kidney disease (OR 3.28; 95% CI, 2.12-5.09), atrial fibrillation (OR 2.43; CI 95%, 1.63-3.61), and heart failure (OR 2.89; 95% CI, 1.91-4.37) were significant predictors of mortality. In hospital complications, such as severe respiratory failure requiring ICU ventilation (OR 23.59; 95% CI, 2.81-197.87), myocardial infarction (OR 25.43; 95% CI, 3.16-204.97), acute kidney injury requiring renal replacement therapy (OR 19.15; 95% CI, 6.49-56.51), sepsis (OR 7.22, 95% CI, 3.77-13.84), stroke, further increased mortality risk. CONCLUSIONS COVID-19 patients with pre-existing renal and cardiovascular conditions face a higher risk of fatal outcomes. Early diagnosis and intervention targeting these complications are vital to in reducing mortality. Further research is needed to reconcile disparities with existing literature.
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Affiliation(s)
- Damian Palus
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | | | - Olga Piątek-Dalewska
- Department of Pulmonology and Allergology, Medical University of Gdansk, Poland
- Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdansk, Poland
| | | | - Krzysztof Kuziemski
- Department of Pulmonology and Allergology, Medical University of Gdansk, Poland
| | - Radosław Owczuk
- Department of Anesthesiology and Intensive Care, Medical University of Gdansk, Poland
| | - Michał Hoffmann
- Department of Hypertension and Diabetology, Medical University of Gdansk, Poland
| | - Dariusz Kozłowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, Poland
| | - Tomasz Stefaniak
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Poland
- Department of Healthcare Quality, Medical University of Gdansk, Poland
- Board of Directors, University Clinical Centre of Medical University of Gdansk, Poland
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Lekkala SP, Mohammed AS, Ahmed H, Al-Sulami M, Khan J, Desai R, Ghantasala P, Singh H, Ali SS, Bianco C. Sex-Specific Risk Factors and Predictors of Major Adverse Cardiac and Cerebrovascular Events in Heart Failure with Preserved Ejection Fraction with SARS-CoV-2 Infection: A Nationwide Analysis. J Clin Med 2025; 14:1469. [PMID: 40094849 PMCID: PMC11900245 DOI: 10.3390/jcm14051469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 01/31/2025] [Accepted: 02/01/2025] [Indexed: 03/19/2025] Open
Abstract
Background: Heart failure with preserved ejection fraction (HFpEF) is a condition with limited large-scale data on the short- and long-term effects of SARS-CoV-2 infection. This study aimed to evaluate the prevalence of major adverse cardiac and cerebrovascular events (MACCEs) in HFpEF patients hospitalized with SARS-CoV-2 and identify sex-specific risk factors and predictors of MACCEs in this population. Methods: This retrospective study analyzed HFpEF patients hospitalized with SARS-CoV-2 from the 2020 National Inpatient Sample (NIS) using ICD-10 codes. Patients hospitalized with HFpEF and SARS-CoV-2 were categorized by age (18-44, 45-64, ≥65 years). Multivariate logistic regression was used to adjust for potential confounders, with the statistical significance set at a two-tailed p-value < 0.05. Results: Among 109,750 HFpEF patients hospitalized with SARS-CoV-2, 31,960 (29.1%) experienced MACCEs. Males experienced a higher rate of MACCEs than females (31.1% vs. 27.5%, OR: 1.20, 95% CI: 1.12-1.28, p < 0.001). Adjusted analysis revealed that elderly patients (≥65 years, OR: 1.47, 95% CI: 1.33-1.62) compared with the 45-64 age group and males (OR: 1.20, 95% CI: 1.12-1.28, p < 0.001) had a higher risk of MACCEs. Key predictors included prior coronary artery bypass grafting (CABG; OR: 1.15, 95% CI: 1.02-1.30), cancer (OR: 1.24, 95% CI: 1.08-1.42), and chronic kidney disease (OR: 1.15, 95% CI: 1.08-1.23). Subgroup analysis identified additional sex-specific risk factors. In males, hyperlipidemia, obesity, tobacco use disorder, prior stroke/transient ischemic attack (TIA), prior venous thromboembolism (VTE), alcohol abuse, depression, and valvular disease were significant predictors of MACCEs. In females, hyperlipidemia, tobacco use disorder, prior stroke/TIA, prior VTE, and depression were significant predictors. Conclusions: HFpEF patients hospitalized with SARS-CoV-2 have a high risk of MACCEs, with male sex, older age, prior CABG, cancer, and chronic kidney disease as key risk factors. This study provides the first large-scale analysis of sex-specific predictors of MACCEs in HFpEF patients hospitalized with SARS-CoV-2. These findings underscore the need for focused research and clinical gender-based strategies to mitigate cardiovascular risks in this unique and high-risk population.
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Affiliation(s)
- Sai Prasanna Lekkala
- Department of Internal Medicine, UCHealth Parkview Medical Center, Pueblo, CO 81003, USA;
| | - Adil Sarvar Mohammed
- Department of Internal Medicine, College of Medicine, Central Michigan University, Saginaw, MI 48859, USA;
| | - Hafeezuddin Ahmed
- Department of Internal Medicine, Corewell Health Beaumont Royal Oak, Royal Oak, MI 48073, USA;
| | - Meshal Al-Sulami
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV 26506, USA; (M.A.-S.); (C.B.)
| | - Jahangir Khan
- Department of Internal Medicine, Covenant Healthcare, Saginaw, MI 48706, USA;
| | - Rupak Desai
- Independent Researcher, Atlanta, GA 30033, USA;
| | - Paritharsh Ghantasala
- Department of Internal Medicine, College of Medicine, Central Michigan University, Saginaw, MI 48859, USA;
| | - Hemindermeet Singh
- Department of Cardiovascular Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, USA; (H.S.); (S.S.A.)
| | - Syed Sohail Ali
- Department of Cardiovascular Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, USA; (H.S.); (S.S.A.)
| | - Christopher Bianco
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV 26506, USA; (M.A.-S.); (C.B.)
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Lee H, Kim SH, Jeong CY, Chung JE, Kim Y, Min KH, Yoo KH, Kim JS, Moon JY. COVID-19 and risk of long-term mortality in COPD: a nationwide population-based cohort study. BMJ Open Respir Res 2025; 12:e002694. [PMID: 39961706 PMCID: PMC11836811 DOI: 10.1136/bmjresp-2024-002694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 12/11/2024] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a risk factor for severe COVID-19. However, mortality after COVID-19 recovery in this population remains unclear. METHODS We retrospectively enrolled individuals with COPD from the Korean National Health Insurance database. We compared the mortality rate in individuals with COPD who recovered from COVID-19 between 8 October 2020 and 31 December 2021 (COVID-19 cohort, n=2499) with that in 1:1 propensity score-matched controls (n=2499). The study population was followed until either death or 30 September 2022, whichever came first. RESULTS The COVID-19 cohort had a 4.8% mortality rate vs 2.7% in matched controls during a median follow-up of 319 days (IQR, 293-422 days), including 14 days of recovery time. The COVID-19 cohort had a higher risk of death than matched controls (adjusted HR (aHR)=1.81, 95% CI=1.35 to 2.45). The risk of mortality was notably higher in individuals with severe COVID-19 (aHR=5.05, 95% CI=3.65 to 6.97), especially during the first 180 days of recovery (highest during the first 30 days (aHR=20.25, 95% CI=7.79 to 52.64)). Non-severe COVID-19 does not increase the risk of mortality compared with controls (aHR=0.85, 95% CI=0.57 to 1.28). CONCLUSION Individuals with COPD recovering from COVID-19 showed an increased risk of long-term mortality, particularly within the first 180 days post-recovery, especially those who experienced severe COVID-19.
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Affiliation(s)
- Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Sang Hyuk Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, South Korea
| | - Cho Yun Jeong
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Jee-Eun Chung
- College of Pharmacy, Hanyang University, Seoul, South Korea
| | - Youlim Kim
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Kyung Hoon Min
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
| | - Jong Seung Kim
- Department of Medical Informatics, Jeonbuk National University Medical School, Jeonju, South Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, South Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, South Korea
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Ramalho-Pinto CH, Ventura LHA, Camatta GC, Silveira-Nunes G, Gomes MS, Sato HI, Costa MS, Guimarães HC, Barbuto RC, Martins-Filho OA, Amaral LR, Bertarini PLL, Teixeira SMR, Tupinambás U, Teixeira-Carvalho A, Faria AMC. Machine learning algorithm approach to complete blood count can be used as early predictor of COVID-19 outcome. J Leukoc Biol 2025; 117:qiae223. [PMID: 39432758 DOI: 10.1093/jleuko/qiae223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 10/18/2024] [Indexed: 10/23/2024] Open
Abstract
Although the SARS-CoV-2 infection has established risk groups, identifying biomarkers for disease outcomes is still crucial to stratify patient risk and enhance clinical management. Optimal efficacy of COVID-19 antiviral medications relies on early administration within the initial 5 d of symptoms, assisting high-risk patients in avoiding hospitalization and improving survival chances. The complete blood count (CBC) can be an efficient and affordable option to find biomarkers that predict the COVID-19 prognosis due to infection-induced alterations in various blood parameters. This study aimed to associate hematological parameters with different COVID-19 clinical forms and utilizes them as disease outcome predictors. We performed a CBC in blood samples from 297 individuals with COVID-19 from Belo Horizonte, Brazil. Statistical analysis, as well as ROC Curves and machine learning Decision Tree algorithms were used to identify correlations, and their accuracy, between blood parameters and disease severity. In the initial 4 d of infection, traditional hematological COVID-19 alterations, such as lymphopenia, were not yet apparent. However, the monocyte percentage and granulocyte-to-lymphocyte ratio (GLR) proved to be reliable predictors for hospitalization, even in cases where patients exhibited mild symptoms that later progressed to hospitalization. Thus, our findings demonstrate that COVID-19 patients with monocyte percentages lower than 7.7% and a GLR higher than 8.75 are assigned to the hospitalized group with a precision of 86%. This suggests that these variables can serve as important biomarkers in predicting disease outcomes and could be used to differentiate patients at hospital admission for managing therapeutic interventions, including early antiviral administration. Moreover, they are simple parameters that can be useful in minimally equipped health care units.
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Affiliation(s)
- Cecília Horta Ramalho-Pinto
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, 31270-901, Belo Horizonte, Brazil
| | - Lucas Haniel Araújo Ventura
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, 31270-901, Belo Horizonte, Brazil
| | - Giovanna Caliman Camatta
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, 31270-901, Belo Horizonte, Brazil
| | - Gabriela Silveira-Nunes
- Departamento de Medicina, Universidade Federal de Juiz de Fora, Av. Doutor Raimundo Monteiro Resende, 330, 35010-177, Governador Valadares, Brazil
| | - Matheus Souza Gomes
- Instituto de Biotecnologia, Universidade Federal de Uberlândia, R. Padre Pavoni, 290, 38701-002, Patos de Minas, Brazil
| | - Hugo Itaru Sato
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, 31270-901, Belo Horizonte, Brazil
| | - Murilo Soares Costa
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, 30130-100, Belo Horizonte, Brazil
| | | | - Rafael Calvão Barbuto
- Hospital Universitário Risoleta Tolentino Neves, R. das Gabirobas, 1, 31744-012, Belo Horizonte, Brazil
| | - Olindo Assis Martins-Filho
- Instituto de Pesquisa René Rachou, Fundação Oswaldo Cruz - MG, Av. Augusto de Lima, 1715, 30190-002, Belo Horizonte, Brazil
| | - Laurence Rodrigues Amaral
- Faculdade de Computação, Universidade Federal de Uberlândia, R. Padre Pavoni, 290, 38701-002, Patos de Minas, Brazil
| | - Pedro Luiz Lima Bertarini
- Faculdade de Engenharia Elétrica, Universidade Federal de Uberlândia, R. Padre Pavoni, 290, 38701-002, Patos de Minas, Brazil
| | - Santuza Maria Ribeiro Teixeira
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, 31270-901, Belo Horizonte, Brazil
| | - Unaí Tupinambás
- Departamento de Medicina, Universidade Federal de Juiz de Fora, Av. Doutor Raimundo Monteiro Resende, 330, 35010-177, Governador Valadares, Brazil
| | - Andrea Teixeira-Carvalho
- Instituto de Pesquisa René Rachou, Fundação Oswaldo Cruz - MG, Av. Augusto de Lima, 1715, 30190-002, Belo Horizonte, Brazil
| | - Ana Maria Caetano Faria
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Pres. Antônio Carlos, 6627, 31270-901, Belo Horizonte, Brazil
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Ramos-Rincón JM, Sánchez-Paya J, González-De-La-Aleja P, Rodríguez-Díaz JC, Merino E. A national population-based study of mortality and risk factors in COVID-19-hospitalized patients in Spain (2020-2021). Front Public Health 2025; 13:1488283. [PMID: 39980912 PMCID: PMC11841506 DOI: 10.3389/fpubh.2025.1488283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 01/21/2025] [Indexed: 02/22/2025] Open
Abstract
Objectives The study aimed to analyze in-hospital mortality (IHM) among all COVID-19 patients hospitalized in Spain between March 1, 2020, and December 31, 2021, and to compare two distinct periods: the prevaccination period (March 1, 2020, to January 31, 2021) and the vaccination period (February 1, 2021, to December 31, 2021). The objective was to assess the impact of vaccination on IHM and identify associated risk factors, using data from Spain's national hospitalization registry. Methods This retrospective analysis used data from the Spanish National Surveillance System for Hospital Data. The primary outcome was in-hospital mortality (IHM). Multivariate logistic regression identified risk factors across the overall study period, as well as during the prevaccination and vaccination periods. Risk factors included age (in 20-year intervals), sex, comorbidities (e.g., hypertension, diabetes, chronic kidney failure, obesity, neurodegenerative disorders, and others), and admission to the intensive care unit. Results A total of 524,314 COVID-19 hospitalizations were recorded in Spain, with 329,690 during the prevaccination period and 194,624 during the vaccination period. Hospitalization rates dropped from 697/100,000 people to 411/100,000, and in-hospital mortality (IHM) decreased from 16.2 to 11.5% (adjusted odds ratio [AOR]: 0.71, 95% CI: 0.70-0.73, p < 0.001). IHM rose with age, from 0.8% in patients aged 18-39 to 31.7% in those ≥80 years (p < 0.001), but significant decreases were observed across all age groups after vaccination, especially in those ≥80 years (AOR: 0.76, 95% CI: 0.75-0.79, p < 0.001). Risk factors for IHM remained consistent, with leukemia, neoplasm, and lymphoma posing the highest risks, while female sex (AOR: 0.75, 95% CI: 0.74-0.77, p < 0.001) and dyslipidemia (AOR: 0.85, 95% CI: 0.32-0.86, p < 0.001) were protective factors. Conclusion During the vaccination period, the risk of in-hospital mortality (IHM) was 29% lower than in the prevaccination period, after adjusting for sex, age, and comorbidities. This reduced risk was observed across sexes, age groups, and comorbidities. The risk factors for IHM remained consistent between the two periods, with age as the main risk factor, while female sex and dyslipidemia were identified as protective factors.
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Affiliation(s)
- José-Manuel Ramos-Rincón
- Department of Internal Medicine, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
- Miguel Hernández University of Elche, Alicante, Spain
| | - José Sánchez-Paya
- Preventive Service, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
| | - Pilar González-De-La-Aleja
- Unit of Infectious Diseases, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
| | - Juan-Carlos Rodríguez-Díaz
- Miguel Hernández University of Elche, Alicante, Spain
- Service of Microbiology, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
| | - Esperanza Merino
- Miguel Hernández University of Elche, Alicante, Spain
- Unit of Infectious Diseases, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain
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Amsalem I, Shafrir A, Kalish Y, Paltiel O. Pre-infection anticoagulant exposure and SARS-CoV-2 infection outcomes - Differential mortality by age. Thromb Res 2025; 246:109254. [PMID: 39799927 DOI: 10.1016/j.thromres.2025.109254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 12/18/2024] [Accepted: 01/06/2025] [Indexed: 01/15/2025]
Abstract
BACKGROUND The risk of thrombosis increases after SARS-CoV-2 infection. This study aimed to assess associations between pre-infection anticoagulant exposure and SARS-CoV-2 infection-related outcomes in a population-based cohort. METHODS Members of the "Meuhedet" health maintenance organization aged >45 years who tested positive for SARS-CoV-2 infection (03/2020-04/2022) were followed. Pre-infection anticoagulant exposure (PAE) was defined as any anticoagulant therapy prescribed ≥1 month prior to SARS-CoV-2 testing. Univariate analyses, multivariable models adjusting for confounders, propensity-score matching, and an age-stratified analysis were performed to assess associations between PAE and hospitalization, intensive care unit (ICU) admission, 30-day and one-year mortality. RESULTS Of the 127,801 patients included, 2951(2.3 %) had PAE. Comorbidities including ischemic heart disease, diabetes mellitus, hypertension, heart failure, and atrial fibrillation were more common among anticoagulant-exposed than unexposed individuals (p < 0.001). Patients with PAE experienced higher hospitalization (22.7 % vs 5.6 %), ICU admissions (1.9 % vs 0.5 %), 30-day and 1-year mortality rates (4.8 % vs. 0.6, and 8.8 % vs. 1.1 %, respectively), than unexposed individuals, but similar lengths-of-stay. In the multivariable analysis, PAE was independently associated only with hospitalizations (adjusted odds ratio (aOR) = 1.29 [95 % confidence interval (CI): 1.13-1.47]), whereas in the propensity-matched analysis, none of the outcomes differed significantly between the groups. However, in the stratum aged >75 years, 30-day and one-year mortality were significantly reduced in those with PAE (aOR = 0.68 [CI:0.48-0.97], and aOR = 0.73 [CI:0.55-0.97], respectively). CONCLUSION SARS-CoV-2-infected individuals with prior exposure to anticoagulants have more comorbidities and experienced a higher incidence of hospitalization but not mortality compared to unexposed patients. Paradoxically, mortality risks decreased in the oldest stratum of anticoagulant-exposed individuals. Further research is required to assess mechanisms for this apparent protective effect.
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Affiliation(s)
- Itshak Amsalem
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Asher Shafrir
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; Meuhedet Health Services, Tel Aviv, Israel; Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yosef Kalish
- Department of Hematology, Hadassah University Medical Center, Jerusalem, Israel
| | - Ora Paltiel
- Department of Hematology, Hadassah University Medical Center, Jerusalem, Israel; Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Abodunrin OR, Olagunju MT, Huang X, Wang J, Hu Z, Shen C. Regional risk factors associated with adverse outcomes of COVID-19 infection among the older adult: A systematic review and meta-analysis. J Infect Public Health 2025; 18:102632. [PMID: 39754850 DOI: 10.1016/j.jiph.2024.102632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 12/13/2024] [Accepted: 12/23/2024] [Indexed: 01/06/2025] Open
Abstract
The rapid global spread of Coronavirus Disease 2019 (COVID-19) has resulted in millions of infections and deaths, particularly impacting older adults. This study systematically analyzes risk factors reported in different geographical regions such as Asia and Europe that are associated with adverse outcomes in older adults with COVID-19. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched five databases up to December 2023 and conducted meta-analyses of odds ratios for 27 risk factors reported in at least two studies using R software (version 4.3.2). Our meta-analysis identified 19 risk factors linked to adverse outcomes, with many of them common across regions, particularly in Asia and Europe. Key factors include old age (above 65 years), male gender, symptoms such as fever and dyspnea, and comorbidities like dementia, chronic obstructive pulmonary disease (COPD), chronic heart disease, hypertension, chronic kidney disease, and malnutrition. Laboratory biomarkers such as low oxygen saturation, thrombocytopenia, and elevated D-dimer were also associated with adverse outcomes. COVID-19 patients in Asia and Europe who are older adults, male, or have specific symptoms combined with underlying health conditions are at an increased risk of progressing to severe illness or mortality.
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Affiliation(s)
- Olunike Rebecca Abodunrin
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Mobolaji Timothy Olagunju
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xinyi Huang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Jianming Wang
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhibin Hu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Chong Shen
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
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He W, Li G, Xu K, Yu B, Sun Y, Zhong K, Zhou D, Yan Y, Wu J, Wang DW. Clinical characteristics and risk factors for in-hospital mortality of COVID-19 patients in Hubei Province: A multicenter retrospective study. IJC HEART & VASCULATURE 2025; 56:101574. [PMID: 39687686 PMCID: PMC11648888 DOI: 10.1016/j.ijcha.2024.101574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 11/24/2024] [Accepted: 11/26/2024] [Indexed: 12/18/2024]
Abstract
Background Coronavirus disease (COVID-19) remains one of the most significant factors threatening public health security worldwide. The COVID-19 pandemic has been ongoing for more than 3 years; however, there are few studies on the clinical characteristics and mortality risk factors in patients with COVID-19 based on comprehensive data from multiple centers. Methods A total of 53,030 patients with confirmed COVID-19 from 138 hospitals in Hubei Province were included in this study. We compared the clinical characteristics between survivors and non-survivors and analyzed the risk factors for in-hospital mortality. Results Among the 53,030 patients with COVID-19, 49,320 (93.0 %) were discharged, and 3,710 (7.0 %) died during hospitalization. Cardiovascular disease was the most common comorbidity, followed by endocrine and digestive diseases. Male sex, >65-year-old, and high diastolic blood pressure, a series of abnormal laboratory test indicators and hyponatremia, hypokalemia, acute respiratory distress syndrome, shock, solid tumor, hematological tumor, and insulin use were independent risk factors for in-hospital mortality of patients with COVID-19. In addition, male sex, older age, and higher disease severity were associated with increased mortality in patients with COVID-19. Conclusion Patients with early COVID-19 in Hubei Province had high mortality and a high proportion of severe cases and initial comorbidities. Cardiovascular disease was the most common comorbidity in patients with COVID-19. Male sex, older age, comorbidities, and abnormal laboratory data have been identified as independent risk factors for in-hospital mortality in patients with COVID-19. Therefore, there should be an increased focus on patients with COVID-19 with these risk factors.
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Affiliation(s)
- Wu He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Gen Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Ke Xu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Bo Yu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Yang Sun
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Kaineng Zhong
- Health Commission of Hubei Province, Wuhan 430079, China
| | - Da Zhou
- Health Commission of Hubei Province, Wuhan 430079, China
| | - Yongcui Yan
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Junfang Wu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
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Autorinnen/Autoren, RACOON Study Group. [Prevalence and prognostic role of thoracic lymphadenopathy in Covid-19]. ROFO-FORTSCHR RONTG 2025; 197:163-171. [PMID: 39038457 DOI: 10.1055/a-2293-8132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
PURPOSE The prevalent coronavirus disease 2019 (COVID-19) pandemic has spread throughout the world and is considered a serious threat to global health. The prognostic role of thoracic lymphadenopathy in COVID-19 is unclear. The aim of the present meta-analysis was to analyze the prognostic role of thoracic lymphadenopathy for the prediction of 30-day mortality in patients with COVID-19. MATERIALS AND METHODS The MEDLINE library, Cochrane, and SCOPUS databases were screened for associations between CT-defined features and mortality in COVID-19 patients up to June 2021. In total, 21 studies were included in the present analysis. The quality of the included studies was assessed by the Newcastle-Ottawa Scale. The meta-analysis was performed using RevMan 5.3. Heterogeneity was calculated by means of the inconsistency index I2. DerSimonian and Laird random-effect models with inverse variance weights were performed without any further correction. RESULTS The included studies comprised 4621 patients. The prevalence of thoracic lymphadenopathy varied between 1 % and 73.4 %. The pooled prevalence was 16.7 %, 95 % CI = (15.6 %; 17.8 %). The hospital mortality was higher in patients with thoracic lymphadenopathy (34.7 %) than in patients without (20.0 %). The pooled odds ratio for the influence of thoracic lymphadenopathy on mortality was 2.13 (95 % CI = [1.80-2.52], p < 0.001). CONCLUSION The prevalence of thoracic lymphadenopathy in COVID-19 is 16.7 %. The presence of thoracic lymphadenopathy is associated with an approximately twofold increase in the risk for hospital mortality in COVID-19. KEY POINTS · The prevalence of lymphadenopathy in COVID-19 is 16.7 %.. · Patients with lymphadenopathy in COVID-19 have a higher risk of mortality during hospitalization.. · Lymphadenopathy nearly doubles mortality and plays an important prognostic role.. CITATION FORMAT · Bucher AM, Sieren M, Meinel F et al. Prevalence and prognostic role of thoracic lymphadenopathy in Covid-19. Rofo 2025; 197: 163 - 171.
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Mineshita M, Nishine H, Handa H, Inoue T, Ishibashi Y, Kawahata K, Kunishima H, Tsuchida T, Takemura H, Minoura A, Takita M, Fujitani S. 90-Day outcomes in patients with severe COVID-19 pneumonia treated with invasive mechanical ventilation. J Infect Chemother 2025; 31:102529. [PMID: 39341596 DOI: 10.1016/j.jiac.2024.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 09/16/2024] [Accepted: 09/24/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND There are few reports detailing the prognostic factors of severe COVID-19 pneumonia requiring invasive ventilation. We investigated the long-term prognosis and evaluated which factors influenced outcomes in these patients. METHODS Data was reviewed from severe adult COVID-19 cases admitted to our hospital and treated with mechanical ventilation between February 1, 2020, and October 30, 2021. On admission to our hospital, comorbidities and laboratory findings were collected from clinical records. Prognostic information for 90 days after diagnosis was also obtained from hospitals where patients were transferred after their conditions stabilized. RESULTS Prognostic information was obtained in 133 patients, of which 106 were males (79.7 %). Of the 133 patients, 67 were discharged (51.5 %), 21 continued inpatient care (15.8 %), and 45 died (33.8 %). Age, Charlson Risk Index, and the number of patients on hemodialysis were significantly higher in the deceased group. There were no differences in therapeutic interventions between survivors and those who died except for a higher rate of muscle relaxant and vasopressor usage in the deceased group. Laboratory findings on admission showed significantly higher levels of BUN, creatinine, and serum Krebs von den Lungen 6 (KL-6), and significantly lower platelet counts, hemoglobin, and alanine aminotransferase in those who died. Multivariate analysis revealed that age, hemodialysis, lower platelet counts, and higher KL-6 were independent predictors for 90-day mortality. CONCLUSIONS Older age, hemodialysis, lower platelet counts and high KL-6 on admission were identified as independent predictors of 90-day mortality in patients with respiratory failure due to severe COVID-19 under invasive mechanical ventilation.
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Affiliation(s)
- Masamichi Mineshita
- Department of Respiratory Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan.
| | - Hiroki Nishine
- Department of Respiratory Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Hiroshi Handa
- Department of Respiratory Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Takeo Inoue
- Department of Respiratory Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Yuki Ishibashi
- Department of Cardiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Kimito Kawahata
- Department of Rheumatology and Allergology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Diseases, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Tomoya Tsuchida
- Department of General Internal Medicine, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Hiromu Takemura
- Department of Microbiology, St. Marianna University School of Medicine, 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Ayu Minoura
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine. 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Mumon Takita
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine. 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care Medicine, St Marianna University School of Medicine. 2-16-1, Sugao, Miyamae-ku, Kawasaki- City, Kanagawa, 216-8511, Japan
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Okushin K, Ikeuchi K, Saito M, Kishida T, Kado A, Fujishiro M, Moriya K, Yotsuyanagi H, Koike K, Tsutsumi T. Use of Ursodeoxycholic Acid and the Risk of Severe Coronavirus Disease 2019 in Elderly Patients with Viral Hepatitis. Intern Med 2025:4856-24. [PMID: 39894493 DOI: 10.2169/internalmedicine.4856-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2025] Open
Abstract
Objective Although the management of coronavirus disease 2019 (COVID-19) has improved, chemoprevention remains a challenge. We recently identified that ursodeoxycholic acid (UDCA) is associated with subclinical infection with severe acute respiratory syndrome coronavirus, implying a reduction in the severity of COVID-19. We analyzed a large medical database to assess the utility of UDCA in the reduction of COVID-19 severity. Methods This retrospective observational study was conducted using a large-scale healthcare administrative claims database. We extracted data on patients who were diagnosed with either chronic hepatitis B or C. Among them, patients >50 years of age diagnosed with COVID-19 before December 2022 were analyzed. Patients were divided into two groups: those with or without a prescription of UDCA. The primary outcome was the in-hospital mortality rate. A propensity score-matching analysis was performed using logistic regression. Results A total of 6,413 patients diagnosed with COVID-19 (UDCA group, n =579; non-UDCA group, n =5,834) were analyzed. The median age was 73.0 (IQR, 64.0-81.0) years, and 57.8% of the patients were men. The UDCA group had significantly more complications with liver cirrhosis, hepatocellular carcinoma, type 2 diabetes, and hypertension. The UDCA group had a higher in-hospital mortality rate than the non-UDCA group, even after propensity score matching (7.4% vs. 4.3%, p =0.03), whereas there was no difference in the risks of hospitalization, oxygen therapy, or ventilation. Conclusions Although the observed increase in mortality among UDCA users could have been due to unmeasured confounding factors, UDCA did not reduce the severity of COVID-19 in viral hepatitis patients.
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Affiliation(s)
- Kazuya Okushin
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kazuhiko Ikeuchi
- Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Japan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Japan
| | - Toshiyuki Kishida
- Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akira Kado
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Kyoji Moriya
- Division of Infection Control and Prevention, Education Research Center, The Tokyo Health Care University, Japan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Japan
| | | | - Takeya Tsutsumi
- Department of Infection Control and Prevention, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Infectious Diseases, Graduate School of Medicine, The University of Tokyo, Japan
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Rubio-Rivas M, Mora-Luján JM, Montero Sáez A, Martín-Escalante MD, Giner Galvañ V, Maestro de la Calle G, Taboada Martínez ML, Muiño Míguez A, Lumbreras-Bermejo C, Antón-Santos JM. Which one is a better predictor of prognosis in COVID-19: analytical biomarkers or PaO2/FiO2? Rev Clin Esp 2025; 225:57-69. [PMID: 39577690 DOI: 10.1016/j.rceng.2024.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 10/19/2024] [Indexed: 11/24/2024]
Abstract
BACKGROUND The study aimed to describe patient characteristics and outcomes by PaO2/FiO2 (PAFI) and degree of inflammation. METHODS Retrospective cohort study with data on patients collected from March 1st, 2020 to March 1st, 2023, from the Spanish SEMI-COVID-19 Registry. Non-nosocomial patients with data on PAFI (<100 vs. 100-200 vs. 200-300 vs. >300) who received corticosteroids (CS) for COVID-19 in the first 48 h of admission were included in the study. 5314 patients met the inclusion criteria for the present study. The primary outcome was in-hospital mortality. RESULTS Higher in-hospital mortality was found in the groups with PAFI < 100 (51.5% vs. 41.2% vs. 25.8% vs. 12.3%, P < .001). They also required more NIMV, IMV, and ICU admission, and had longer hospital stays. Those patients with PAFI > 300 and 4-5 high-risk criteria presented higher mortality than the patients with PAFI 200-300 and only 1-2 criteria of analytical inflammation. Risk factors associated with higher in-hospital mortality were age [OR = 1.06 (1.05-1.06)], moderate [OR = 1.87 (1.49-2.33)] and severe [OR = 2.64 (1.96-3.55)] degree of dependency, dyslipidemia [OR = 1.20 (1.03-1.39)], higher Charlson index [OR = 1.19 (1.14-1.24)], tachypnea on admission [2.23 (1.91-2.61)], the higher number of high-risk criteria on admission, and lower PAFI on admission. Female gender [OR = 0.77 (0.65-0.90)] and the use of RDSV [OR = 0.72 (0.56-0.93)] were found to be protective factors. CONCLUSIONS The lower the PAFI and the higher the degree of inflammation in COVID-19, the higher the in-hospital mortality. Inflammatory escalation precedes respiratory deterioration and should serve as an early predictor of severity to deciding the use of anti-inflammatory/immunosuppressive therapy.
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Affiliation(s)
- M Rubio-Rivas
- Department of Internal Medicine, Bellvitge University Hospital, Barcelona, Spain.
| | - J M Mora-Luján
- Department of Internal Medicine, Parc Sanitari Hospital del Mar, Barcelona, Spain
| | - A Montero Sáez
- Department of Internal Medicine, Bellvitge University Hospital, Barcelona, Spain
| | - M D Martín-Escalante
- Department of Internal Medicine, Costa del Sol Hospital, Marbella, Málaga, Spain
| | - V Giner Galvañ
- Department of Internal Medicine, San Juan de Alicante University Hospital, Alicante, Spain
| | | | | | - A Muiño Míguez
- Department of Internal Medicine, Gregorio Marañón University Hospital, Madrid, Spain
| | - C Lumbreras-Bermejo
- Department of Internal Medicine, 12 de Octubre University Hospital, Madrid, Spain
| | - J-M Antón-Santos
- Department of Internal Medicine, Infanta Cristina University Hospital, Parla, Madrid, Spain
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Conlin K, Jenkin D, de Whalley P, Weckx LY, Folegatti PM, Bibi S, Lambe T, Aley PK, Pollard AJ, Voysey M, Costa Clemens SA. Predictors of severity of SARS-CoV-2 infections in Brazil: Post hoc analyses of a randomised controlled trial. Vaccine 2025; 45:126582. [PMID: 39675209 DOI: 10.1016/j.vaccine.2024.126582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 11/28/2024] [Accepted: 11/29/2024] [Indexed: 12/17/2024]
Abstract
OBJECTIVES To identify demographic, clinical and immunological factors associated with adverse COVID-19 outcomes. METHODS A large randomised controlled trial of ChAdOx1 nCoV-19 was undertaken in Brazil. Participants were randomised 1:1 either to receive ChAdOx1 nCov-19 or to a control group. COVID-19 infections were confirmed by nucleic acid amplification test (NAAT) and classified using the WHO clinical progression scale. Anti-spike antibody responses and serum neutralising activity were measured 28 days after second vaccination in some participants. Exploratory analyses were conducted into factors associated with COVID-19 infection severity and hospitalisation, using logistic regression models adjusted for demographic and clinical factors. RESULTS 10,416 participants were enrolled; 1790 had NAAT-positive COVID-19 infection; 63 cases required hospitalisation. More severe infection was associated with greater body-mass index (BMI) (odds ratio [OR] = 1.06 [95 %CI: 1.01-1.10], p = 0.01) and diabetes (OR = 3.67 [1.59-8.07], p = 0.003). Hospitalisation risk increased with greater age (OR = 1.06 [1.03-1.08], p < 0.001) and BMI (OR = 1.10 [1.05-1.16], p < 0.001). More severe infection and hospitalisation risks increased >180 days after last vaccination. In the fully vaccinated subgroup (n = 841), only greater age predicted hospitalisation (OR = 1.07 [1.03-1.12], p < 0.001). Serological responses to two vaccine doses diminished with age. CONCLUSIONS Unvaccinated individuals with high BMI and diabetes risked more severe COVID-19 outcomes. Vaccination mitigated this risk. CLINICAL TRIAL REGISTRATION NUMBER NCT04536051.
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Affiliation(s)
- Kerry Conlin
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Daniel Jenkin
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Philip de Whalley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Lily Yin Weckx
- Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil.
| | - Pedro M Folegatti
- Jenner Institute, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Sagida Bibi
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Teresa Lambe
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Chinese Academy of Medical Sciences Oxford Institute, University of Oxford, Oxford, UK.
| | - Parvinder K Aley
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Andrew J Pollard
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK.
| | - Sue Ann Costa Clemens
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, UK; Institute of Global Health, University of Siena, Siena, Brazil.
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Göttert EAF. What is fair? Ethical analysis of triage criteria and disability rights during the COVID-19 pandemic and the German legislation. JOURNAL OF MEDICAL ETHICS 2025; 51:139-143. [PMID: 37973368 DOI: 10.1136/jme-2023-109326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/28/2023] [Indexed: 11/19/2023]
Abstract
This essay discusses the ethical challenges and dilemmas in allocating scarce medical resources during the COVID-19 pandemic, using the German legislative process as a starting point. It is guided by the right to non-discrimination of people with disability and generally contrasts utilitarian and rights-based principles of allocation. Three approaches that were suggested in the German discussion, are presented, the lottery principle, the first come first served principle and the probability to survive principle. Arguments in favour and against each principle are discussed. The focus is on the utilitarian probability to survive principle, which was adopted in German legislation in 2022, and its discriminatory potential against people with disability. The essay suggests ways to mitigate the concerns of discrimination related to the probability to survive principle. It concludes that resolving the triage dilemma requires a balanced approach between utilitarian and rights-based concerns, which promotes both maximising the number of patients surviving and the right not to be discriminated against and be treated equally. It calls for a further debate on how many ethical values such as equity, fairness and non-discrimination we are willing to sacrifice for a higher number of survivors and when we are willing to sacrifice survivors to secure ethical values.
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Affiliation(s)
- Elena Ana Francesca Göttert
- Institute for Ethics, History and Philosophy of Medicine, Medizinische Hochschule Hannover, Hannover, Germany
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de Castro MV, Sábato C, Dandalo-Girardi RM, Silva MVR, Dell'Aquila LP, Razuk-Filho Á, Batista-Júnior PB, Naslavsky MS, Zatz M. Insights into disease resilience and longevity: Hints from COVID-19 recovered nonagenarians and centenarians. Gene 2025; 934:149025. [PMID: 39437899 DOI: 10.1016/j.gene.2024.149025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 10/17/2024] [Accepted: 10/18/2024] [Indexed: 10/25/2024]
Abstract
The effects of aging on the organism manifest in various ways, including profound and complex changes in functioning patterns, responses to stimuli, and regenerative capacity. Nevertheless, it is remarkable that some elderly individuals maintain their health and functionality despite advanced age, showing resilience to environmental adversities, such as SARS-CoV-2 infection. In this study, we examined a unique cohort of 100 individuals older than 90 years, including centenarians, who recovered from COVID-19 before the availability of vaccines in Brazil. We performed whole-exome analyses and identified incidental findings in four participants. These findings included pathogenic variants associated with serious conditions, such as cancer predisposition and cardiovascular diseases. Specifically, variants were found in the RYR1, DSP, BRCA2, BRCA1, and TTN genes. Also, other two individuals were homozygous for rare variants in the TYK2 gene, related to primary immunodeficiencies. The significance of these findings is underscored by the fact that, despite carrying these rare variants, these individuals surpassed 90 years of age and survived the COVID-19 pandemic. This suggests the presence of genetic protective factors that contribute to longevity and resilience. Therefore, this study provides new insights into interpreting incidental findings in long-lived populations and raises important questions for clinical practice and the genetics of longevity.
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Affiliation(s)
- Mateus V de Castro
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, SP, Brazil
| | - Cristina Sábato
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, SP, Brazil
| | | | - Monize V R Silva
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Michel S Naslavsky
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, SP, Brazil
| | - Mayana Zatz
- Human Genome and Stem Cell Research Center, University of São Paulo, São Paulo, SP, Brazil.
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Martins ELC, Constantino P, de Oliveira GLA. The effectiveness of non-exposure to incarceration in preventing COVID-19 and mitigating associated events: a systematic review and meta-analysis. BMC Public Health 2025; 25:206. [PMID: 39825252 PMCID: PMC11740558 DOI: 10.1186/s12889-024-20859-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 11/25/2024] [Indexed: 01/20/2025] Open
Abstract
BACKGROUND For a long time, the penalty of imprisonment has been studied and criticized as ineffective in achieving the goals of resocialization and rehabilitation of offenders, and studies have associated incarceration with increased prevalence of disease. In response to the COVID-19 pandemic, the World Health Organization recommended decarceration as a prevention measure. The aim of this review was to analyze the effectiveness of non-exposure to incarceration in preventing COVID-19 and mitigating associated events. METHODS We conducted a systematic review and meta-analysis of observational studies comparing the adult general population (GP) and incarcerated population (IP). RESULTS We identified 1,334 publications without duplicates and extracted data from 22 studies. We found that COVID-19 incidence was 61% lower in the GP (RR = 0.39 [0.34, 0.45], p < 0.0001). Non-exposure to incarceration was associated with lower age- and sex-adjusted mortality (RR = 0.36, [0.27, 0.49], p < 0.0001). We did not find standardized data on age-adjusted case fatality. The hospitalized GP was older and showed a higher rate of obesity than the hospitalized IP; however, no statistically significant differences were found between the populations for admission to intensive care (RR = 0,91 [0.74, 1.13], p = 0.41) and hospital mortality (RR = 0.81 [0.54, 1.23], p = 0.32). Prevalence of the use of invasive mechanical ventilation was 23% lower in the GP (RR = 0.77 [0.70, 0.84, p < 0.0001). CONCLUSION Non-exposure to incarceration can be a strategy for preventing the spread of COVID-19 and reduces COVID-19 mortality in younger populations. Despite differences in age distribution and presence of comorbidities among the hospitalized GP and IP, we did not find any statistically significant differences between the two populations across most of the hospital-related outcomes. These findings should be interpreted with caution because it was not possible to determine a cause-and-effect relationship between the COVID-19 outcomes and exposure to incarceration. REGISTRATION PROSPERO CRD42023446610.
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Affiliation(s)
| | - Patrícia Constantino
- National School of Public Health (ENSP)/Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
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Fargier PB, Damin-Pernik M, Launay M, Gagneux-Brunon A, Bellet F, Beyens MN. COVID-19 infection and risk of adverse drug reactions: Cohort study. Therapie 2025:S0040-5957(25)00002-2. [PMID: 39843284 DOI: 10.1016/j.therap.2024.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 12/18/2024] [Accepted: 12/31/2024] [Indexed: 01/24/2025]
Abstract
AIM During coronavirus disease 2019 (COVID-19), the incidence rate of adverse drug reactions (ADRs) in hospitalized patients seemed higher than before the pandemic. Severe inflammation triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was cited as an explanation. We aimed to determine whether COVID-19 infection was associated with a higher risk of ADRs compared to other infectious diseases. METHODS A monocentric historic cohort, "exposed/unexposed" study, was conducted in the university hospital of Saint-Étienne (inclusion period from March 05, 2020 to April 16, 2020 for "COVID-19" and from January to December 2019 for "non-COVID-19"). All ADRs reported in patients' medical records were retrospectively assessed using Bégaud et al.'s algorithm. A multivariable Cox regression was performed to assess the hazard ratio (HR). RESULTS The incidence rate of 4.64 ADRs per person-month in the "COVID-19" group did not differ from the 3.52 ADRs per person-month in the "non-COVID-19" group (multivariable adjusted HR 1.29, 95% confidence interval [CI], 0.91-1.81, P=0.1436). COVID-19 patients had more hepatobiliary disorders whereas non-COVID-19 patients had more renal and urinary disorders. Classes of drugs mostly involved in ADRs occurrence were antibiotics, followed by antithrombotics in both groups. Compared to patients with no ADR, patients with ADRs had higher C-reactive protein (CRP) levels and a lower estimated glomerular filtration rate (eGFR). CONCLUSION In this study, the incidence rate in hospitalized patients with COVID-19 was not statistically different from that in the group with another infection. High CRP levels, as well as low eGFR, were the main risk factors for the occurrence of ADRs and should be considered in further ADR prevention strategies.
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Affiliation(s)
- Paul-Benoît Fargier
- Centre régional de pharmacovigilance, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France.
| | - Marlène Damin-Pernik
- Centre régional de pharmacovigilance, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France
| | - Manon Launay
- Centre régional de pharmacovigilance, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France
| | - Amandine Gagneux-Brunon
- CIC Inserm 1408 vaccinologie, service d'infectiologie, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | - Florelle Bellet
- Centre régional de pharmacovigilance, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France
| | - Marie-Noëlle Beyens
- Centre régional de pharmacovigilance, hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex, France
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Cheng HI, Chang KW, Wu BC, Teo MY, Hung WS, Wu HM, Huang ACC, Lin CW, Lin TY, Lin HC, Chiu CH, Lin SM. Comparison of Clinical Characteristics and Mortality Outcome in Critical COVID-19 Patients Infected with Alpha and Omicron Variants. Infect Drug Resist 2025; 18:151-160. [PMID: 39803308 PMCID: PMC11725234 DOI: 10.2147/idr.s479896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 12/19/2024] [Indexed: 01/16/2025] Open
Abstract
Objective Early reports have indicated that the Omicron variant of coronavirus disease 2019 (COVID-19) may be associated with low mortality. However, the mortality rate of critical patients in Taiwan with COVID-19 caused by different variants has not been well described. Methods This retrospective cohort study was conducted at the Linkou Branch of Chang Gung Memorial Hospital, Taiwan, from April 2020 to September 2022. Critically ill patients who had confirmed SARS-CoV-2 infection and were on mechanical ventilation (MV) were enrolled. Demographic data, laboratory results, and treatment information were collected and analyzed. In addition, clinical outcomes for different SARS-CoV-2 variants were analyzed. Results This study included 110 critical patients with COVID-19 who required intubation and intensive care unit (ICU) admission. Among these patients, 46 (41.8%) required intensive care during Alpha predominance period and 64 (58.2%) during the Omicron predominance period. The Alpha group had a higher body mass index, had a longer ICU stay, and included more patients with acute respiratory distress syndrome, and the Omicron group included more active smokers, had more comorbidities, had worse initial laboratory data (including higher white blood cell counts, prothrombin time [PT], activated partial prothrombin time, blood urine nitrogen levels, and creatine levels), and had higher in-hospital mortality rates (40.6% vs 15.2%, p = 0.004). The independent risk factors for in-hospital mortality, were Charlson Comorbidity Index (CCI) ≥ 3 and higher PT and creatine levels. Conclusion Our study discovered that CCI ≥ 3, elevated serum creatine levels, and prolonged PT were independently associated with a high mortality rate in patients with critical COVID-19. Patients with those risk factors may require intensive monitoring during their treatment course.
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Affiliation(s)
- Hsin-I Cheng
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Ko-Wei Chang
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Bing-Chen Wu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Mei-Yuan Teo
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Wei-Syun Hung
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Hao-Ming Wu
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | | | - Chang-Wei Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ting-Yu Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Horng-Chyuan Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
| | - Cheng-Hsun Chiu
- Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
- Molecular Infectious Disease Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Min Lin
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkuo, Taiwan
- Department of Respiratory Therapy, Chang Gung Memorial Hospital, Linkuo, Taiwan
- School of Medicine, National Tsing Hua University, Hsin-Chu, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Isnard S, Mabanga T, Royston L, Berini CA, Bu S, Aiyana O, Feng H, Lebouché B, Costiniuk CT, Cox J, Kroemer G, Durand M, Routy JP, the Biobanque Québécoise de la COVID-19 (BQC-19). Extracellular acyl-CoA-binding protein as an independent biomarker of COVID-19 disease severity. Front Immunol 2025; 15:1505752. [PMID: 39835130 PMCID: PMC11743960 DOI: 10.3389/fimmu.2024.1505752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Accepted: 12/12/2024] [Indexed: 01/22/2025] Open
Abstract
Background Factors leading to severe COVID-19 remain partially known. New biomarkers predicting COVID-19 severity that are also causally involved in disease pathogenesis could improve patient management and contribute to the development of innovative therapies. Autophagy, a cytosolic structure degradation pathway is involved in the maintenance of cellular homeostasis, degradation of intracellular pathogens and generation of energy for immune responses. Acyl-CoA binding protein (ACBP) is a key regulator of autophagy in the context of diabetes, obesity and anorexia. The objective of our work was to assess whether circulating ACBP levels are associated with COVID-19 severity, using proteomics data from the plasma of 903 COVID-19 patients. Methods Somalogic proteomic analysis was used to detect 5000 proteins in plasma samples collected between March 2020 and August 2021 from hospitalized participants in the province of Quebec, Canada. Plasma samples from 903 COVID-19 patients collected during their admission during acute phase of COVID-19 and 295 hospitalized controls were assessed leading to 1198 interpretable proteomic profiles. Levels of anti-SARS-CoV-2 IgG were measured by ELISA and a cell-binding assay. Results The median age of the participants was 59 years, 46% were female, 65% had comorbidities. Plasma ACBP levels correlated with COVID-19 severity, in association with inflammation and anti-SARS-CoV-2 antibody levels, independently of sex or the presence of comorbidities. Samples collected during the second COVID-19 wave in Quebec had higher levels of plasma ACBP than during the first wave. Plasma ACBP levels were negatively correlated with biomarkers of T and NK cell responses interferon-γ, tumor necrosis factor-α and interleukin-21, independently of age, sex, and severity. Conclusions Circulating ACBP levels can be considered a biomarker of COVID-19 severity linked to inflammation. The contribution of extracellular ACBP to immunometabolic responses during viral infection should be further studied.
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Affiliation(s)
- Stephane Isnard
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Tsoarello Mabanga
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Léna Royston
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Carolina A. Berini
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Simeng Bu
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Orthy Aiyana
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Hansen Feng
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Bertrand Lebouché
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Cecilia T. Costiniuk
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Joseph Cox
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
| | - Guido Kroemer
- Centre de Recherche des Cordeliers, Equipe labellisée par la Ligue contre le cancer, Université de Paris, Sorbonne Université, Inserm U1138, Institut Universitaire de France, Paris, France
- Metabolomics and Cell Biology Platforms, Institut Gustave Roussy, Villejuif, France
- Institut du Cancer Paris CARPEM, Department of Biology, Hôpital Européen Georges Pompidou, assistance publique des hôpitaux de Paris (AP-HP), Paris, France
| | - Madeleine Durand
- Département de Microbiologie, Infectiologie et Immunologie, Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Jean-Pierre Routy
- Inflammation and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, McGill University Health Centre, Montreal, QC, Canada
- Division of Hematology, McGill University Health Centre, Montreal, QC, Canada
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50
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Shah DP, Thaweethai T, Karlson EW, Bonilla H, Horne BD, Mullington JM, Wisnivesky JP, Hornig M, Shinnick DJ, Klein JD, Erdmann NB, Brosnahan SB, Lee-Iannotti JK, Metz TD, Maughan C, Ofotokun I, Reeder HT, Stiles LE, Shaukat A, Hess R, Ashktorab H, Bartram L, Bassett IV, Becker JH, Brim H, Charney AW, Chopra T, Clifton RG, Deeks SG, Erlandson KM, Fierer DS, Flaherman VJ, Fonseca V, Gander JC, Hodder SL, Jacoby VL, Kotini-Shah P, Krishnan JA, Kumar A, Levy BD, Lieberman D, Lin JJ, Martin JN, McComsey GA, Moukabary T, Okumura MJ, Peluso MJ, Rosen CJ, Saade G, Shah PK, Sherif ZA, Taylor BS, Tuttle KR, Urdaneta AE, Wallick JA, Wiley Z, Zhang D, Horwitz LI, Foulkes AS, Singer NG. Sex Differences in Long COVID. JAMA Netw Open 2025; 8:e2455430. [PMID: 39841477 PMCID: PMC11755195 DOI: 10.1001/jamanetworkopen.2024.55430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 11/08/2024] [Indexed: 01/23/2025] Open
Abstract
Importance A substantial number of individuals worldwide experience long COVID, or post-COVID condition. Other postviral and autoimmune conditions have a female predominance, but whether the same is true for long COVID, especially within different subgroups, is uncertain. Objective To evaluate sex differences in the risk of developing long COVID among adults with SARS-CoV-2 infection. Design, Setting, and Participants This cohort study used data from the National Institutes of Health (NIH) Researching COVID to Enhance Recovery (RECOVER)-Adult cohort, which consists of individuals enrolled in and prospectively followed up at 83 sites in 33 US states plus Washington, DC, and Puerto Rico. Data were examined from all participants enrolled between October 29, 2021, and July 5, 2024, who had a qualifying study visit 6 months or more after their initial SARS-CoV-2 infection. Exposure Self-reported sex (male, female) assigned at birth. Main Outcomes and Measures Development of long COVID, measured using a self-reported symptom-based questionnaire and scoring guideline at the first study visit that occurred at least 6 months after infection. Propensity score matching was used to estimate risk ratios (RRs) and risk differences (95% CIs). The full model included demographic and clinical characteristics and social determinants of health, and the reduced model included only age, race, and ethnicity. Results Among 12 276 participants who had experienced SARS-CoV-2 infection (8969 [73%] female; mean [SD] age at infection, 46 [15] years), female sex was associated with higher risk of long COVID in the primary full (RR, 1.31; 95% CI, 1.06-1.62) and reduced (RR, 1.44; 95% CI, 1.17-1.77) models. This finding was observed across all age groups except 18 to 39 years (RR, 1.04; 95% CI, 0.72-1.49). Female sex was associated with significantly higher overall long COVID risk when the analysis was restricted to nonpregnant participants (RR, 1.50; 95%: CI, 1.27-1.77). Among participants aged 40 to 54 years, the risk ratio was 1.42 (95% CI, 0.99-2.03) in menopausal female participants and 1.45 (95% CI, 1.15-1.83) in nonmenopausal female participants compared with male participants. Conclusions and Relevance In this prospective cohort study of the NIH RECOVER-Adult cohort, female sex was associated with an increased risk of long COVID compared with male sex, and this association was age, pregnancy, and menopausal status dependent. These findings highlight the need to identify biological mechanisms contributing to sex specificity to facilitate risk stratification, targeted drug development, and improved management of long COVID.
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Affiliation(s)
- Dimpy P. Shah
- Long School of Medicine, University of Texas Health Science Center, San Antonio
| | - Tanayott Thaweethai
- Massachusetts General Hospital Biostatistics, Somerville
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | | | - Hector Bonilla
- Division of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California
| | - Benjamin D. Horne
- Intermountain Heart Institute, Intermountain Health, Salt Lake City, Utah
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Janet M. Mullington
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mady Hornig
- Columbia University Mailman School of Public Health, New York, New York
- RECOVER Patient, Caregiver, or Community Representative, New York, New York
| | | | - Jonathan D. Klein
- Department of Pediatrics, Stanford University, Palo Alto, California
- Illinois Research Network, University of Illinois Chicago
| | - Nathaniel B. Erdmann
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Shari B. Brosnahan
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Joyce K. Lee-Iannotti
- Department of Neurology, University of Arizona College of Medicine, Phoenix
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix
| | - Torri D. Metz
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City
| | - Christine Maughan
- RECOVER Patient, Caregiver, or Community Representative, New York, New York
| | - Ighovwerha Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Harrison T. Reeder
- Massachusetts General Hospital Biostatistics, Somerville
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lauren E. Stiles
- RECOVER Patient, Caregiver, or Community Representative, New York, New York
- Stony Brook University Renaissance School of Medicine, Stony Brook, New York
| | - Aasma Shaukat
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Rachel Hess
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City
- Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, Salt Lake City
| | | | - Logan Bartram
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Jacqueline H. Becker
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hassan Brim
- Howard University College of Medicine, Washington, DC
| | - Alexander W. Charney
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Rebecca G. Clifton
- Department of Epidemiology, The George Washington University, Washington, DC
| | - Steven G. Deeks
- Department of Medicine, University of California San Francisco
| | - Kristine M. Erlandson
- Division of Infectious Diseases, Department of Medicine, University of Colorado–Anschutz Medical Campus, Aurora
| | - Daniel S. Fierer
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Valerie J. Flaherman
- Department of Pediatrics, University of California San Francisco
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Vivian Fonseca
- Department of Medicine, Tulane University Health Sciences Center, New Orleans, Louisiana
| | - Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente of Georgia, Atlanta
- Centre College, Danville, Kentucky
| | - Sally L. Hodder
- Department of Medicine, West Virginia University, Morgantown
| | | | | | | | - Andre Kumar
- Division of Infectious Diseases, Department of Medicine, Stanford University, Palo Alto, California
| | | | | | - Jenny J. Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey N. Martin
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Grace A. McComsey
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | | | | | - George Saade
- Department of Obstetrics and Gynecology, The University of Texas Medical Branch, Galveston
| | - Pankil K. Shah
- Long School of Medicine, University of Texas Health Science Center, San Antonio
| | | | - Barbara S. Taylor
- Long School of Medicine, University of Texas Health Science Center, San Antonio
| | | | - Alfredo E. Urdaneta
- Department of Emergency Medicine, Division of Emergency Critical Care, Stanford University, Palo Alto, California
| | | | - Zanthia Wiley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - David Zhang
- Biological Sciences Division, University of Chicago, Chicago, Illinois
| | - Leora I. Horwitz
- Department of Medicine, NYU Grossman School of Medicine, New York, New York
| | - Andrea S. Foulkes
- Massachusetts General Hospital Biostatistics, Somerville
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Nora G. Singer
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
- MetroHealth Medical Center, Cleveland
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